Provider Demographics
NPI:1710650346
Name:WELLS, AMANDA LEE (AUD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEE
Last Name:WELLS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 TREMONT DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-2936
Mailing Address - Country:US
Mailing Address - Phone:502-403-8955
Mailing Address - Fax:
Practice Address - Street 1:3100 TREMONT DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-2936
Practice Address - Country:US
Practice Address - Phone:502-403-8955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY271513231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist