Provider Demographics
NPI:1225221534
Name:OGLE, AMANDA JAYNE (MACCC-SLP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JAYNE
Last Name:OGLE
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3009 LEGG LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37924-1302
Mailing Address - Country:US
Mailing Address - Phone:865-933-2846
Mailing Address - Fax:
Practice Address - Street 1:2931 ESSARY RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-2404
Practice Address - Country:US
Practice Address - Phone:865-748-5242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1704235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist