Provider Demographics
NPI:1245510189
Name:WEISSERT, AMANDA LYNNE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LYNNE
Last Name:WEISSERT
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1291 SPRING CREEK DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-5154
Mailing Address - Country:US
Mailing Address - Phone:785-317-3832
Mailing Address - Fax:
Practice Address - Street 1:529 MIDWAY CIR
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5178
Practice Address - Country:US
Practice Address - Phone:785-317-3832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-23
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4067235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist