Individual
AMANDA WYGRYS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS-SLP-CCC
Contact information
Practice address
4208 RETAMA CIR, VICTORIA, TX 77901-2765
(361) 578-2257
(361) 578-2260
Mailing address
4208 RETAMA CIR, VICTORIA, TX 77901-2765
(613) 578-2257
(361) 578-2260
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
119734
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
119734
TEXAS LICENSE
TX
Enumeration date
06/15/2022
Last updated
06/15/2022
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