MEDICARE: MRS. AMY JEAN WOODALL M.A.,CCC-A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	51078	TX

General Provider Information

NPI Number	:	1083887103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMY JEAN WOODALL M.A.,CCC-A

Provider Business Mailing Address
First Line	:	4407 BEE CAVES RD 112
Second Line	:
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-6498
Country	:	US
Telephone Number	:	512-328-4999
Fax Number	:

Provider Business Practice Location Address
First Line	:	8830 LONG POINT RD STE 806
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77055-3028
Country	:	US
Telephone Number	:	713-464-2614
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2008
Last Update Date	:	09/22/2015

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