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Individual

AMANDA RANDOLPH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
SLP

Contact information

Practice address
1539 COUNTRY CLUB RD, FAIRMONT, WV 26554-1306
(304) 363-8479
(304) 366-9125
Mailing address
1403 BROCKTON DR, MORGANTOWN, WV 26508-8749
(304) 288-7830

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
12053347
WV

Other

Enumeration date
03/23/2007
Last updated
08/27/2009
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