Provider Demographics
NPI:1598926321
Name:PAUL, AMARA LEIGH (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AMARA
Middle Name:LEIGH
Last Name:PAUL
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:AMARA
Other - Middle Name:LEIGH
Other - Last Name:DAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30036 MESSARA CV
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-7843
Mailing Address - Country:US
Mailing Address - Phone:352-360-5803
Mailing Address - Fax:
Practice Address - Street 1:30036 MESSARA CV
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-7843
Practice Address - Country:US
Practice Address - Phone:352-360-5803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 9427235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist