Provider Demographics
NPI:1437509460
Name:PERME, AMANDA LEE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEE
Last Name:PERME
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:LEE
Other - Last Name:GIBSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SLP
Mailing Address - Street 1:300 W WIEUCA RD NE STE 115
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-3352
Mailing Address - Country:US
Mailing Address - Phone:404-808-5427
Mailing Address - Fax:833-661-9958
Practice Address - Street 1:300 W WIEUCA RD NE STE 115
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-3352
Practice Address - Country:US
Practice Address - Phone:404-808-5427
Practice Address - Fax:833-661-9958
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP009309235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist