Individual
AMANDA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12924 W 64TH DR APT A, ARVADA, CO 80004-6024
(517) 316-5042
Mailing address
12924 W 64TH DR APT A, ARVADA, CO 80004-6024
(517) 316-5042
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
242.003032
IL
235Z00000X
Speech-Language Pathologist
Primary
SLP.0004212
CO
Other
Enumeration date
06/18/2014
Last updated
03/12/2026
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