Provider Demographics
NPI:1366922049
Name:WILLIAMS, AMANDA N
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:N
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 N GATEWAY BLVD APT 2105
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-5194
Mailing Address - Country:US
Mailing Address - Phone:601-316-9060
Mailing Address - Fax:
Practice Address - Street 1:721 S HIGHWAY 78
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-4004
Practice Address - Country:US
Practice Address - Phone:972-303-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113739235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist