Provider Demographics
NPI:1164869277
Name:LEDDIGE, AMANDA D (AUD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:D
Last Name:LEDDIGE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:D
Other - Last Name:BOUTILIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:705 BREMNER AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-3001
Mailing Address - Country:US
Mailing Address - Phone:701-751-6232
Mailing Address - Fax:
Practice Address - Street 1:4900 OTTAWA ST STE 300
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-6156
Practice Address - Country:US
Practice Address - Phone:701-751-6232
Practice Address - Fax:701-751-6235
Is Sole Proprietor?:No
Enumeration Date:2013-05-30
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDH-0318237700000X
ND1262231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist