Provider Demographics
NPI:1487309480
Name:WOOD, AMANDA CHRISTINE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:CHRISTINE
Last Name:WOOD
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:CHRISTINE
Other - Last Name:CARRASCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6633 KATIE CORRAL DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76126-5448
Mailing Address - Country:US
Mailing Address - Phone:956-455-2121
Mailing Address - Fax:
Practice Address - Street 1:309 N PEARSON ST
Practice Address - Street 2:
Practice Address - City:GODLEY
Practice Address - State:TX
Practice Address - Zip Code:76044-3738
Practice Address - Country:US
Practice Address - Phone:817-592-4169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111552235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist