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NPI Code Detail

MEDICARE: MRS. AMANDA NELSON

MEDICARE: MRS. AMANDA NELSON
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
1235Z00000XSpeech-Language PathologistCOND.2016174OH

General Provider Information

NPI Number : 1659731917
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. AMANDA NELSON
Provider Business Mailing Address
First Line : 27 BROADWAY ST
Second Line : APT. 214
City : TOLEDO
State : OH
Zip : 43604-8769
Country : US
Telephone Number : 330-207-3894
Fax Number :
Provider Business Practice Location Address
First Line : 5601 CLEGG DR
Second Line :
City : TOLEDO
State : OH
Zip : 43613-2022
Country : US
Telephone Number : 419-473-8490
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2016
Last Update Date : 03/01/2016

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Directions to “ MRS. AMANDA NELSON ” Practice Location

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