Provider Demographics
NPI:1174035042
Name:OLMEDA, AMANDA B (SLPA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:B
Last Name:OLMEDA
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:B
Other - Last Name:RAMOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4342 W GREENWAY RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-3618
Mailing Address - Country:US
Mailing Address - Phone:602-575-5660
Mailing Address - Fax:
Practice Address - Street 1:1000 E NARRAMORE AVE
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326
Practice Address - Country:US
Practice Address - Phone:623-386-9706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-31
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA106432355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant