Provider Demographics
NPI:1255078028
Name:ANDREWS-OHLMAN, MIRYAM T (LMSW)
Entity type:Individual
Prefix:
First Name:MIRYAM
Middle Name:T
Last Name:ANDREWS-OHLMAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:MIRYAM
Other - Middle Name:
Other - Last Name:STONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:524 15TH ST
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-2151
Mailing Address - Country:US
Mailing Address - Phone:309-736-7170
Mailing Address - Fax:
Practice Address - Street 1:524 15TH ST
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-2151
Practice Address - Country:US
Practice Address - Phone:309-736-7170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-13
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA081465104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker