Provider Demographics
NPI:1972940369
Name:WRIGHT, AMANDA CLARK (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:CLARK
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2984 MAHALA LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-8555
Mailing Address - Country:US
Mailing Address - Phone:606-205-9094
Mailing Address - Fax:
Practice Address - Street 1:8000 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:KY
Practice Address - Zip Code:40361-2157
Practice Address - Country:US
Practice Address - Phone:859-987-2106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-27
Last Update Date:2013-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3827235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist