Provider Demographics
NPI:1710417043
Name:KNAGGS, TAMMY MARIE (MSW-LSW)
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:MARIE
Last Name:KNAGGS
Suffix:
Gender:F
Credentials:MSW-LSW
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:MARIE
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:6629 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43617
Mailing Address - Country:US
Mailing Address - Phone:567-806-4808
Mailing Address - Fax:567-806-4808
Practice Address - Street 1:6629 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43617
Practice Address - Country:US
Practice Address - Phone:567-806-4808
Practice Address - Fax:567-806-4808
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-19
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1802598251S00000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH344428488Medicaid
OH0386880Medicaid