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Individual

AMY K NELSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LCSW

Contact information

Practice address
621 N LAKE PARKER AVE, LAKELAND, FL 33801-2040
(863) 519-0575
(863) 733-4496
Mailing address
PO BOX 1559, BARTOW, FL 33831-1559

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
SW11248
FL
171M00000X
Case Manager/Care Coordinator

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
003556600
FL
05
008428900
FL
Enumeration date
04/14/2011
Last updated
12/26/2018
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