| Doctor Name: | MRS. AMANDA JEAN RUSSELL |
| NPI Number: | 1801021829 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA CF/SLP |
| License Number: | KY08071 |
| Business Practice Address: | 4150 Alexandria Pike Ste 108 Cold Spring, KY - 410763500 |
| Business Phone Number: | 8595720430 |
| Business Fax Number: | 8595720163 |
| Mailing Address: | 4150 Alexandria Pike Ste 108, COLD SPRING |
| State: | KY |
| Postal Code: | 410763500 |
| Phone Number: | 8595720430 |
| Fax Number: | 8595720163 |
| NPI Enumeration Date: | 05/19/2009 |
| NPI Last Update Date: | 05/19/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | KY08071 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |