Provider Demographics
NPI:1881025526
Name:EASTWOOD, AMY NICOLE (MSW, LISW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:NICOLE
Last Name:EASTWOOD
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:NICOLE
Other - Last Name:HOLLENBECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2507 W RAUCH RD
Mailing Address - Street 2:
Mailing Address - City:TEMPERANCE
Mailing Address - State:MI
Mailing Address - Zip Code:48182-9606
Mailing Address - Country:US
Mailing Address - Phone:419-343-6036
Mailing Address - Fax:
Practice Address - Street 1:123 22ND ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-1082
Practice Address - Country:US
Practice Address - Phone:419-241-6191
Practice Address - Fax:419-255-5623
Is Sole Proprietor?:No
Enumeration Date:2013-12-05
Last Update Date:2016-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH07007341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH104100000XMedicaid