Doctor Name: | MRS. AMANDA TANDY |
NPI Number: | 1497150676 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | ED.S. |
License Number: | OH1285747 |
Business Practice Address: | 2141 Laurel Ln Streetsboro, OH - 442415892 |
Business Phone Number: | 3305773149 |
Business Fax Number: | |
Mailing Address: | 2141 Laurel Ln, STREETSBORO |
State: | OH |
Postal Code: | 442415892 |
Phone Number: | 3305773149 |
Fax Number: | |
NPI Enumeration Date: | 10/29/2014 |
NPI Last Update Date: | 10/29/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TS0200X |
License Number: | OH1285747 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | School |
Taxonomy Definition: |