Provider Demographics
NPI:1033417126
Name:VALASEK, AMANDA LEEANN
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:LEEANN
Last Name:VALASEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4709 N 148TH STREET
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-1453
Mailing Address - Country:US
Mailing Address - Phone:402-614-9121
Mailing Address - Fax:
Practice Address - Street 1:4709 N 148TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-1453
Practice Address - Country:US
Practice Address - Phone:402-614-9121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1013235Z00000X
IA01519235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist