Healthcare Provider Details

I. General information

NPI: 1245510189
Provider Name (Legal Business Name): AMANDA LYNNE WEISSERT M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMANDA JOHNSON

II. Dates (important events)

Enumeration Date: 08/23/2011
Last Update Date: 12/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 MIDWAY CIR
BRENTWOOD TN
37027-5178
US

IV. Provider business mailing address

1291 SPRING CREEK DR
NASHVILLE TN
37209-5154
US

V. Phone/Fax

Practice location:
  • Phone: 785-317-3832
  • Fax:
Mailing address:
  • Phone: 785-317-3832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4067
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: