MEDICARE: AMANDA WERNER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	123011	TX

General Provider Information

NPI Number	:	1437984440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA WERNER

Provider Business Mailing Address
First Line	:	5841 RECREATION DR APT 2214
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-1064
Country	:	US
Telephone Number	:	630-957-8470
Fax Number	:

Provider Business Practice Location Address
First Line	:	5755 CLEARFORK MAIN ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-3596
Country	:	US
Telephone Number	:	817-952-5857
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2024
Last Update Date	:	09/09/2024

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Directions to “ AMANDA WERNER ” Practice Location

Language	Start Address	Practice Location

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