Active NPI
Amanda Wilson, MA, CCC-SLP
- Speech-Language Pathologist
- Kealakekua, HI
National Provider Identifier
1104641331
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SP-2046
- Practice address
- 81-1080 Konawaena School Rd
Kealakekua, HI 96750-8188 - Phone
- (808) 480-1086
- NPI assigned
- Nov 21, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SP-2046 | HI | Primary |
Addresses
Primary practice location
81-1080 Konawaena School Rd
Kealakekua, HI 96750-8188
Mailing address
75-1290 Keopu Mauka Dr
Holualoa, HI 96725-9637
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SP-2046 | HI | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1732147200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1732147200000",
"number": "1104641331",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "75-1290 KEOPU MAUKA DR",
"city": "HOLUALOA",
"state": "HI",
"postal_code": "967259637"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "81-1080 KONAWAENA SCHOOL RD",
"city": "KEALAKEKUA",
"state": "HI",
"postal_code": "967508188",
"telephone_number": "808-480-1086"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "AMANDA",
"credential": "MA, CCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-11-21",
"last_updated": "2024-11-21",
"certification_date": "2024-11-21",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "HI",
"license": "SP-2046",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kealakekua, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.