Provider Demographics
NPI:1003535576
Name:PHILEN, AMANDA MARIE (SLP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:PHILEN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2742 GOLD RUSH LN
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78410-2212
Mailing Address - Country:US
Mailing Address - Phone:210-389-0885
Mailing Address - Fax:
Practice Address - Street 1:2505 WALDRON RD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78418-4798
Practice Address - Country:US
Practice Address - Phone:361-694-9650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112839235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist