Provider Demographics
NPI:1801913678
Name:WARD, AMANDA SUZETTE (MCD, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:SUZETTE
Last Name:WARD
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:MRS
Other - First Name:AMANDA
Other - Middle Name:SUZETTE
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MCD, CCC-SLP
Mailing Address - Street 1:2304 COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:HEBER SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72543-3438
Mailing Address - Country:US
Mailing Address - Phone:870-243-7734
Mailing Address - Fax:
Practice Address - Street 1:2918 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4802
Practice Address - Country:US
Practice Address - Phone:501-279-9255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-24
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#1726235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5U808OtherSPEECH THERAPY
AR145234721Medicaid