Active NPI
Amber Dawn Wyman, SLP
- Speech-Language Pathologist
- Clovis, NM
National Provider Identifier
1508936550
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 5156
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| License | State | Type | Specialty |
|---|---|---|---|
| 3934 | NM | MD | Speech-Language Assistant |
| 5156 | NM | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New 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.
-
- Local Education Agency (LEA)
- Clovis, NM
- NPI 1174662316
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.