Individual provider Active NPI

Amber Dawn Wyman, SLP

  • Speech-Language Pathologist
  • Clovis, NM
National Provider Identifier
1508936550
Registry record updated Sep 26, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
5156 Issued in NM
Practice address
1600 Sutter PL
Clovis, NM 88101-4611
Phone
(575) 769-4490
Fax
(575) 769-4541
NPI assigned
Nov 8, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Assistant 2355S0801X 3934 NM
Speech-Language Pathologist 235Z00000X 5156 NM Primary

Addresses

Primary practice location

1600 Sutter PL
Clovis, NM 88101-4611

Mailing address

911 E 13TH St
Clovis, NM 88101-6121
Phone (505) 749-2003

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

State licenses

LicenseStateTypeSpecialty
3934NMMDSpeech-Language Assistant
5156NMMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Clovis Municipal Schools Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1348617600000",
    "number": "1508936550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "911 E 13TH ST",
            "city": "CLOVIS",
            "state": "NM",
            "postal_code": "881016121",
            "telephone_number": "505-749-2003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 SUTTER PL",
            "city": "CLOVIS",
            "state": "NM",
            "postal_code": "881014611",
            "telephone_number": "575-769-4490",
            "fax_number": "575-769-4541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYMAN",
        "first_name": "AMBER",
        "middle_name": "DAWN",
        "credential": "SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-08",
        "last_updated": "2012-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2355S0801X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Speech-Language Assistant",
            "state": "NM",
            "license": "3934",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NM",
            "license": "5156",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clovis, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.