Provider Demographics
NPI:1861607202
Name:PADGETT-STEWART, AMANDA LYNN (SLP, LMP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LYNN
Last Name:PADGETT-STEWART
Suffix:
Gender:F
Credentials:SLP, LMP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:PADGETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP, LMP
Mailing Address - Street 1:12007 E MANSFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-4740
Mailing Address - Country:US
Mailing Address - Phone:509-954-4625
Mailing Address - Fax:509-315-5045
Practice Address - Street 1:2510 N PINES RD STE 1
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-7636
Practice Address - Country:US
Practice Address - Phone:509-315-5711
Practice Address - Fax:509-443-4170
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00011484174400000X
WALL61209260235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialist