Provider Demographics
NPI:1184212060
Name:HENSLEY, AMANDA ANN
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:ANN
Last Name:HENSLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 668
Mailing Address - Street 2:
Mailing Address - City:WOODWARD
Mailing Address - State:OK
Mailing Address - Zip Code:73802-0668
Mailing Address - Country:US
Mailing Address - Phone:580-256-6063
Mailing Address - Fax:
Practice Address - Street 1:1610 2ND ST
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:OK
Practice Address - Zip Code:73801-4961
Practice Address - Country:US
Practice Address - Phone:580-256-6063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-06
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist