Healthcare Provider Details

I. General information

NPI: 1497058077
Provider Name (Legal Business Name): AMANDA FREEMAN WORTMAN MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2010
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W MARION ST
SHELBY NC
28150-5338
US

IV. Provider business mailing address

127 BEECHNUT CREEK RD
CASAR NC
28020-9763
US

V. Phone/Fax

Practice location:
  • Phone: 704-476-8000
  • Fax:
Mailing address:
  • Phone: 704-473-5762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number6212
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: