Individual
MRS. AMANDA BETH LONGWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S. CCC/SLP
Contact information
Practice address
230 GRANDE MDWS, BRIDGEPORT, WV 26330-9711
(304) 592-2009
(304) 592-2004
Mailing address
1701 MORGANTOWN AVE, FAIRMONT, WV 26554-4513
(304) 366-8498
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP-0901
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7402351-000
—
WV
Enumeration date
10/06/2006
Last updated
07/08/2007
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