Provider Demographics
NPI:1164805347
Name:NORTH, AMANDA RENEE (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:RENEE
Last Name:NORTH
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:RENEE
Other - Last Name:STEPHENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:4803 HORSEMAN DR NE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-5642
Mailing Address - Country:US
Mailing Address - Phone:765-437-4976
Mailing Address - Fax:
Practice Address - Street 1:4803 HORSEMAN DR NE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24019-5642
Practice Address - Country:US
Practice Address - Phone:765-437-4976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4168-154235Z00000X
VA2202008092235Z00000X
MN9511235Z00000X
IN22005045A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist