Provider Demographics
NPI:1851630289
Name:PLANT, AMANDA L (LISW-S)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:L
Last Name:PLANT
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:L
Other - Last Name:KRUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:PO BOX 4670
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43058-4670
Mailing Address - Country:US
Mailing Address - Phone:740-522-8477
Mailing Address - Fax:740-788-3424
Practice Address - Street 1:14 SANDALWOOD DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-9233
Practice Address - Country:US
Practice Address - Phone:740-788-8850
Practice Address - Fax:740-788-8851
Is Sole Proprietor?:No
Enumeration Date:2013-02-05
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS1000827104100000X
OHI13021491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker