Provider Demographics
NPI:1154677524
Name:SALMONS, AMANDA RAE (MS, CFYSLP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:RAE
Last Name:SALMONS
Suffix:
Gender:F
Credentials:MS, CFYSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 KANAWHA BLVD E
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25305-0330
Mailing Address - Country:US
Mailing Address - Phone:304-558-2696
Mailing Address - Fax:304-558-3741
Practice Address - Street 1:1900 KANAWHA BLVD E
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25305-0330
Practice Address - Country:US
Practice Address - Phone:304-558-2696
Practice Address - Fax:304-558-3741
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-03
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV0506235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist