Provider Demographics
NPI:1861279564
Name:ROWE, AMANDA ROSALES (CERTIFIED MSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:ROSALES
Last Name:ROWE
Suffix:
Gender:F
Credentials:CERTIFIED MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MARION VA HEALTH CARE SYSTEM
Mailing Address - Street 2:2401 WEST MAIN STREET
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959
Mailing Address - Country:US
Mailing Address - Phone:866-289-3300
Mailing Address - Fax:
Practice Address - Street 1:1253 PARIS RD STE A
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-4989
Practice Address - Country:US
Practice Address - Phone:270-247-2455
Practice Address - Fax:270-247-7841
Is Sole Proprietor?:No
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY258237104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker