Provider Demographics
NPI:1578801270
Name:MCCLURE, AMANDA LYNN (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LYNN
Last Name:MCCLURE
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 1:49187 808TH RD
Mailing Address - Street 2:
Mailing Address - City:SCOTIA
Mailing Address - State:NE
Mailing Address - Zip Code:68875-5155
Mailing Address - Country:US
Mailing Address - Phone:419-707-2712
Mailing Address - Fax:
Practice Address - Street 1:1102 N HARRISON ST
Practice Address - Street 2:
Practice Address - City:ONEILL
Practice Address - State:NE
Practice Address - Zip Code:68763-2230
Practice Address - Country:US
Practice Address - Phone:402-336-2384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-30
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1546235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist