Provider Demographics
NPI:1619249117
Name:CRANE, AMANDA SKILLING (SLP)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:SKILLING
Last Name:CRANE
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:PO BOX 589
Mailing Address - Street 2:
Mailing Address - City:ROYSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30662-0589
Mailing Address - Country:US
Mailing Address - Phone:706-245-1822
Mailing Address - Fax:706-245-1854
Practice Address - Street 1:613 COOK ST
Practice Address - Street 2:
Practice Address - City:ROYSTON
Practice Address - State:GA
Practice Address - Zip Code:30662-3933
Practice Address - Country:US
Practice Address - Phone:706-245-1822
Practice Address - Fax:706-245-1854
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-31
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006892235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist