Provider Demographics
NPI:1508000902
Name:GILBERT, AMANDA L (SLP-CCC, BCBA)
Entity Type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:L
Last Name:GILBERT
Suffix:
Gender:F
Credentials:SLP-CCC, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BX 1667
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445
Mailing Address - Country:US
Mailing Address - Phone:843-628-2935
Mailing Address - Fax:843-628-2935
Practice Address - Street 1:222 REDBANK RD
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445
Practice Address - Country:US
Practice Address - Phone:843-628-2935
Practice Address - Fax:843-628-2935
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-29
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4183235Z00000X
SC1-10-7083103K00000X
1-10-7083103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4183Medicaid