MEDICARE: AMANDA MCCOY

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	235Z00000X	Speech-Language Pathologist	1590032680	WI

General Provider Information

NPI Number	:	1265390694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA MCCOY

Provider Business Mailing Address
First Line	:	3151 AMSTERDAM PRAIRIE RD
Second Line	:
City	:	HOLMEN
State	:	WI
Zip	:	54636-1003
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3600 SANDLAKE RD
Second Line	:
City	:	HOLMEN
State	:	WI
Zip	:	54636-8125
Country	:	US
Telephone Number	:	608-781-0974
Fax Number	:

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

Provider Enumeration Date	:	01/14/2026
Last Update Date	:	01/14/2026

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Directions to “ AMANDA MCCOY ” Practice Location

Language	Start Address	Practice Location

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