Provider Demographics
NPI:1659828101
Name:WADAMS, AMANDA M (SLP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:M
Last Name:WADAMS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5507 BRIDGE AVE DOWN
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44102-6832
Mailing Address - Country:US
Mailing Address - Phone:908-448-6740
Mailing Address - Fax:
Practice Address - Street 1:5507 BRIDGE AVE DOWN
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44102-6832
Practice Address - Country:US
Practice Address - Phone:908-448-6740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP11935235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist