Provider Demographics
NPI:1083887103
Name:WOODALL, AMY JEAN (MA,CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:JEAN
Last Name:WOODALL
Suffix:
Gender:F
Credentials:MA,CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4407 BEE CAVES RD 112
Mailing Address - Street 2:
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6498
Mailing Address - Country:US
Mailing Address - Phone:512-328-4999
Mailing Address - Fax:
Practice Address - Street 1:8830 LONG POINT RD STE 806
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-3028
Practice Address - Country:US
Practice Address - Phone:713-464-2614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-09
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51078231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist