Doctor Name: | AMANDA BREA POWELL |
NPI Number: | 1457785909 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | SLPA8514 |
Business Practice Address: | 31645 N Royal Oak Way San Tan Valley, AZ - 851436341 |
Business Phone Number: | 4806773349 |
Business Fax Number: | |
Mailing Address: | 7831 E Culver St, MESA |
State: | AZ |
Postal Code: | 852071205 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 09/01/2013 |
NPI Last Update Date: | 09/01/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2355S0801X |
License Number: | SLPA8514 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Specialist/Technologist |
Taxonomy Specialization: | Speech-Language Assistant |
Taxonomy Definition: |