Individual
AMANDA ELIZABETH EDGERTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC, SLP
Contact information
Practice address
185 CHARLOIS BLVD, WINSTON SALEM, NC 27103-1521
(336) 725-0222
Mailing address
185 CHARLOIS BLVD, WINSTON SALEM, NC 27103-1521
(336) 725-0222
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
30000460
NC
235Z00000X
Speech-Language Pathologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30000460
SPEECH LANGUAGE PATHOLOGY
NC
Enumeration date
05/10/2021
Last updated
04/08/2022
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