Provider Demographics
NPI:1376311571
Name:MURRAY, AMANDA N (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:N
Last Name:MURRAY
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 SOMERVELLE ST APT 401
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-8216
Mailing Address - Country:US
Mailing Address - Phone:704-773-5468
Mailing Address - Fax:
Practice Address - Street 1:191 SOMERVELLE ST APT 401
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-8216
Practice Address - Country:US
Practice Address - Phone:704-773-5468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202010985235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist