Doctor Name: | AMANDA WILSON |
NPI Number: | 1265878649 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 1410 W Daisy Bates Dr Little Rock, AR - 722025434 |
Business Phone Number: | 5013757811 |
Business Fax Number: | |
Mailing Address: | 2520 W Main St, JACKSONVILLE |
State: | AR |
Postal Code: | 720764214 |
Phone Number: | 5019820528 |
Fax Number: | |
NPI Enumeration Date: | 05/13/2013 |
NPI Last Update Date: | 05/13/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |