Provider Demographics
NPI:1306401047
Name:KIRLIN, AMANDA K (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:K
Last Name:KIRLIN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 DAVIS TEE
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-6024
Mailing Address - Country:US
Mailing Address - Phone:307-267-8096
Mailing Address - Fax:
Practice Address - Street 1:352 WHITNEY LN
Practice Address - Street 2:STE 101
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-6490
Practice Address - Country:US
Practice Address - Phone:307-267-8096
Practice Address - Fax:307-672-0075
Is Sole Proprietor?:No
Enumeration Date:2019-05-08
Last Update Date:2019-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYSP-587235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist