Healthcare Provider Details

I. General information

NPI: 1528979424
Provider Name (Legal Business Name): MRS. AMY VANCE WILEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 HARRINGTON HWY
EDEN NC
27288-7547
US

IV. Provider business mailing address

278 WILD FERN LN
REIDSVILLE NC
27320-9697
US

V. Phone/Fax

Practice location:
  • Phone: 336-627-2600
  • Fax:
Mailing address:
  • Phone: 336-627-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number10311
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: