Provider Demographics
NPI:1144427519
Name:DEVERA, AMANDA TREDWAY (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:TREDWAY
Last Name:DEVERA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 ARDEN AVENUE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-1116
Mailing Address - Country:US
Mailing Address - Phone:818-649-1475
Mailing Address - Fax:818-649-1476
Practice Address - Street 1:327 ARDEN AVENUE
Practice Address - Street 2:SUITE 201
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-1116
Practice Address - Country:US
Practice Address - Phone:818-649-1475
Practice Address - Fax:818-649-1476
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS3145235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist