Provider Demographics
NPI:1740949460
Name:WILLIAMS, AMANDA LESLIE (HIS, AAS)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LESLIE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:HIS, AAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104B E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-1924
Mailing Address - Country:US
Mailing Address - Phone:509-876-0555
Mailing Address - Fax:
Practice Address - Street 1:104B E MAIN ST
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-1924
Practice Address - Country:US
Practice Address - Phone:509-876-0555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61135132237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist