Provider Demographics
NPI:1821136094
Name:WEAVER, AMANDA JOYCE (MS, AUD, CCC-SLP/A)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:JOYCE
Last Name:WEAVER
Suffix:
Gender:F
Credentials:MS, AUD, CCC-SLP/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 HOSPITAL DR STE 300
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-4666
Mailing Address - Country:US
Mailing Address - Phone:409-981-1700
Mailing Address - Fax:409-981-1784
Practice Address - Street 1:740 HOSPITAL DR STE 300
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4666
Practice Address - Country:US
Practice Address - Phone:409-283-2555
Practice Address - Fax:409-283-8446
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111632235Z00000X
TX51535231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1821136094OtherNPI
TXTXB107371OtherMEDICARE INDIVIDUAL PTAN
TX1821136094OtherNPI