Provider Demographics
NPI:1013314772
Name:GILMORE, AMANDA (EDS)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:
Last Name:GILMORE
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:SCHNEIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:202 NEW CASTLE DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:OH
Mailing Address - Zip Code:44202-6729
Mailing Address - Country:US
Mailing Address - Phone:513-267-0570
Mailing Address - Fax:
Practice Address - Street 1:1175 HUDSON RD
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-2109
Practice Address - Country:US
Practice Address - Phone:330-676-8627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-24
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3029826103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool