Provider Demographics
NPI:1871751636
Name:EDWARDS, AMANDA GAYLE (AUD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:GAYLE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 THREE LAKES PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-0642
Mailing Address - Country:US
Mailing Address - Phone:903-747-4050
Mailing Address - Fax:
Practice Address - Street 1:2210 THREE LAKES PKWY STE 100
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-0642
Practice Address - Country:US
Practice Address - Phone:903-747-4050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX511622355A2700X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No2355A2700XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistAudiology Assistant