Active NPI
Amanda Leigh Wallace, M.A. CF-SLP
- Speech-Language Pathologist
- Tiffin, OH
National Provider Identifier
1578964888
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- COND. 2014271
- Practice address
- 928 W Market St
Tiffin, OH 44883-2529 - Phone
- (419) 270-0041
- NPI assigned
- Sep 7, 2014
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | COND. 2014271 | OH | Primary |
Addresses
Primary practice location
928 W Market St
Tiffin, OH 44883-2529
Mailing address
10 Carolina Dr
Perrysburg, OH 43551-3616
Phone (419) 270-0041
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 |
|---|---|---|---|
| COND. 2014271 | OH | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1410048000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1410048000000",
"number": "1578964888",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 CAROLINA DR",
"city": "PERRYSBURG",
"state": "OH",
"postal_code": "435513616",
"telephone_number": "419-270-0041"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "928 W MARKET ST",
"city": "TIFFIN",
"state": "OH",
"postal_code": "448832529",
"telephone_number": "419-270-0041"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "AMANDA",
"middle_name": "LEIGH",
"name_prefix": "Mrs.",
"credential": "M.A. CF-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-09-07",
"last_updated": "2014-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "OH",
"license": "COND. 2014271",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tiffin, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.