Provider Demographics
NPI:1770975773
Name:WILDMAN, AMANDA (MS, CF-SLP)
Entity type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:
Last Name:WILDMAN
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 MILLERS RUN RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15017-1348
Mailing Address - Country:US
Mailing Address - Phone:412-692-3441
Mailing Address - Fax:
Practice Address - Street 1:205 MILLERS RUN RD
Practice Address - Street 2:
Practice Address - City:BRIDGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15017-1348
Practice Address - Country:US
Practice Address - Phone:412-692-3441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-27
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist