Individual
AMANDA J WOOLERY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
245 LAKELAND DR, ATHENS, GA 30607-2014
(706) 207-4806
Mailing address
245 LAKELAND DR, ATHENS, GA 30607-2014
(706) 207-4806
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP001834
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SLP001834
STATE LICENSE
GA
Enumeration date
05/24/2012
Last updated
05/24/2012
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