Provider Demographics
NPI:1215216312
Name:SPEED, AMANDA A (BS,BM)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:A
Last Name:SPEED
Suffix:
Gender:F
Credentials:BS,BM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1385
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92263-1385
Mailing Address - Country:US
Mailing Address - Phone:760-567-5565
Mailing Address - Fax:
Practice Address - Street 1:400 S EL CIELO RD
Practice Address - Street 2:SUITE E/F
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-7926
Practice Address - Country:US
Practice Address - Phone:760-416-1753
Practice Address - Fax:760-416-0263
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-08
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator