Provider Demographics
NPI:1124442454
Name:VOLLMAR-GORHAM, AMY
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:VOLLMAR-GORHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3281 UPTON AVE
Mailing Address - Street 2:RM 1100
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43613-5109
Mailing Address - Country:US
Mailing Address - Phone:419-671-8866
Mailing Address - Fax:
Practice Address - Street 1:3281 UPTON AVE
Practice Address - Street 2:RM 1100
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43613-5109
Practice Address - Country:US
Practice Address - Phone:419-671-8866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH1314414103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool