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General NPI Number Information
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NPI Number | 1245510189
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Entity Type | Individual
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Provider Name | AMANDA LYNNE WEISSERT M.S., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 08/23/2011
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Last Update Date | 12/19/2017
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Provider Practice Location Address
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Address Line | 529 MIDWAY CIR
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City | BRENTWOOD
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State | TN
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Zip | 37027-5178
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Country | US
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Telephone | 785-317-3832
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Fax |
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Provider Business Mailing Address
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Address Line | 1291 SPRING CREEK DR
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City | NASHVILLE
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State | TN
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Zip | 37209-5154
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Country | US
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Telephone | 785-317-3832
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 4067
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License Number State | TN
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