Provider Demographics
NPI:1376041947
Name:ABNER, AMANDA CHARLEE (CF-SLP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:CHARLEE
Last Name:ABNER
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25345 SAINT ANNE ST
Mailing Address - Street 2:
Mailing Address - City:SORRENTO
Mailing Address - State:FL
Mailing Address - Zip Code:32776-9669
Mailing Address - Country:US
Mailing Address - Phone:386-747-2495
Mailing Address - Fax:
Practice Address - Street 1:2705 REBECCA LN STE B
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8336
Practice Address - Country:US
Practice Address - Phone:386-532-8255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-29
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ8467235Z00000X
CA29518235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist