Provider Demographics
NPI:1740306968
Name:BROOKS, AMANDA CAINES (MS-CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:CAINES
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MS-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:RR 2 BOX 2221
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:WV
Mailing Address - Zip Code:25570-9748
Mailing Address - Country:US
Mailing Address - Phone:304-962-4133
Mailing Address - Fax:
Practice Address - Street 1:RR 2 BOX 2221
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:WV
Practice Address - Zip Code:25570-9748
Practice Address - Country:US
Practice Address - Phone:304-962-4133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP-1147235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist