Provider Demographics
NPI:1417313495
Name:LEE, AMANDA (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:PROCTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10130 GRANT RD
Mailing Address - Street 2:SUITE. #218
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-4531
Mailing Address - Country:US
Mailing Address - Phone:281-807-6325
Mailing Address - Fax:
Practice Address - Street 1:10130 GRANT RD
Practice Address - Street 2:SUITE. #218
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4531
Practice Address - Country:US
Practice Address - Phone:281-807-6325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-06
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110225235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist