Provider Demographics
NPI:1487154522
Name:WINGFIELD, AMANDA (HIS)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:WINGFIELD
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 HARRODSBURG RD STE C212
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-1751
Mailing Address - Country:US
Mailing Address - Phone:859-276-4327
Mailing Address - Fax:
Practice Address - Street 1:1401 HARRODSBURG RD STE C212
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-1751
Practice Address - Country:US
Practice Address - Phone:859-276-4327
Practice Address - Fax:859-309-3010
Is Sole Proprietor?:No
Enumeration Date:2018-02-15
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY101838237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY101838OtherHEARING INSTRUMENT SPECIALIST