Provider Demographics
NPI:1164451894
Name:DUQUETTE, AMANDA MELTON (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:MELTON
Last Name:DUQUETTE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:KAY
Other - Last Name:MELTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:2756 HARRIS ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-4148
Mailing Address - Country:US
Mailing Address - Phone:541-337-0966
Mailing Address - Fax:
Practice Address - Street 1:2756 HARRIS ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-4148
Practice Address - Country:US
Practice Address - Phone:541-337-0966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12560235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist