Individual
MRS. AMANDA COFFMAN BRILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S. CCC SLP
Contact information
Practice address
1840 AMHERST ST, WINCHESTER, VA 22604
(540) 536-1126
(540) 536-5139
Mailing address
PO BOX 471, WARDENSVILLE, WV 26851
(540) 560-2553
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
12100992
—
235Z00000X
Speech-Language Pathologist
Primary
2202005059
VA
235Z00000X
Speech-Language Pathologist
SLP-1095
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12100992
ASHA CCC
—
01
—
2202005059
STATE SLP LICENSE
VA
05
—
3810009984
—
WV
01
—
SLP-1095
STATE SLP LICENSE
WV
Enumeration date
06/08/2007
Last updated
10/29/2007
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