Provider Demographics
NPI:1841287950
Name:DUDDLESON, AMANDA JANE (MSW, LSW)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:JANE
Last Name:DUDDLESON
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 E MADISON ST
Mailing Address - Street 2:P.O. BOX 1240
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-2322
Mailing Address - Country:US
Mailing Address - Phone:574-280-1234
Mailing Address - Fax:574-280-4605
Practice Address - Street 1:415 E MADISON ST
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-2322
Practice Address - Country:US
Practice Address - Phone:574-280-1234
Practice Address - Fax:574-280-4605
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker