Healthcare Provider Details

I. General information

NPI: 1063523637
Provider Name (Legal Business Name): AMANDA DAWN LAMBERT SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 VIRGINIA AVENUE HEARTLAND REHABILITATION SERVICES
WYTHEVILLE VA
24382
US

IV. Provider business mailing address

342 VIRGINIA AVENUE HEARTLAND REHABILITATION SERVICES
WYTHEVILLE VA
24382
US

V. Phone/Fax

Practice location:
  • Phone: 276-228-6200
  • Fax: 276-228-9175
Mailing address:
  • Phone: 276-228-6200
  • Fax: 276-228-9175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202004776
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: