Provider Demographics
NPI:1760037170
Name:LOOMAN, AMANDA (LCDC III)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:LOOMAN
Suffix:
Gender:F
Credentials:LCDC III
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:LOOMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCDC III
Mailing Address - Street 1:316 N MICHIGAN ST STE 914
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-5665
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:316 N MICHIGAN ST STE 914
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-5665
Practice Address - Country:US
Practice Address - Phone:419-246-9405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-04
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health