MEDICARE: MS. AMANDA MARIE WILLIAMS SPEECH LANGUAGE PATH

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	1175	ND

General Provider Information

NPI Number	:	1639457112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMANDA MARIE WILLIAMS SPEECH LANGUAGE PATH

Provider Business Mailing Address
First Line	:	3175 SIENNA DR S STE 103
Second Line	:
City	:	FARGO
State	:	ND
Zip	:	58104-8910
Country	:	US
Telephone Number	:	701-532-1906
Fax Number	:	701-532-1896

Provider Business Practice Location Address
First Line	:	3175 SIENNA DR S STE 103
Second Line	:
City	:	FARGO
State	:	ND
Zip	:	58104-8910
Country	:	US
Telephone Number	:	701-532-1906
Fax Number	:	701-532-1896

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

Provider Enumeration Date	:	08/01/2011
Last Update Date	:	10/25/2022

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Directions to “ MS. AMANDA MARIE WILLIAMS SPEECH LANGUAGE PATH” Practice Location

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