Provider Demographics
NPI:1598149809
Name:SEPULVEDA, AMANDA (SLP)
Entity Type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:
Last Name:SEPULVEDA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3029 SOLAR POINT LN
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-2021
Mailing Address - Country:US
Mailing Address - Phone:915-209-9194
Mailing Address - Fax:
Practice Address - Street 1:12440 ROJAS DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79928
Practice Address - Country:US
Practice Address - Phone:915-937-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-16
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111374235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist