Provider Demographics
NPI:1962940213
Name:WILLIAMSON, AMANDA D (MA, SLP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:D
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:MA, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 EDUCATION LN
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT
Mailing Address - State:WV
Mailing Address - Zip Code:25550-1152
Mailing Address - Country:US
Mailing Address - Phone:304-675-4540
Mailing Address - Fax:
Practice Address - Street 1:1 EDUCATION LN
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT
Practice Address - State:WV
Practice Address - Zip Code:25550-1152
Practice Address - Country:US
Practice Address - Phone:304-675-4540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVP/SLP-0687235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist