Provider Demographics
NPI:1083845861
Name:NEVITT, AMANDA L (MA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:L
Last Name:NEVITT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2103 HEADWATER LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-7858
Mailing Address - Country:US
Mailing Address - Phone:512-347-9530
Mailing Address - Fax:
Practice Address - Street 1:5701 SPRINGDALE RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-3646
Practice Address - Country:US
Practice Address - Phone:512-919-5356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50312231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist