Basic Information
| Provider Information | |||||||||
| NPI: | 1831514223 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GODSEY | ||||||||
| FirstName: | AMANDA | ||||||||
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| Credential: | SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8823 PRODUCTION LN | ||||||||
| Address2: | |||||||||
| City: | OOLTEWAH | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373636511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232387217 | ||||||||
| FaxNumber: | 4232387217 | ||||||||
| Practice Location | |||||||||
| Address1: | 311 CONGRESS PKWY N STE 800 | ||||||||
| Address2: | |||||||||
| City: | ATHENS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373031697 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237440890 | ||||||||
| FaxNumber: | 4237440849 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2014 | ||||||||
| LastUpdateDate: | 02/25/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | CLINICAL FELLOW | TN | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.