Provider Demographics
NPI:1619285350
Name:HERRERA, AMANDA LYNN (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LYNN
Last Name:HERRERA
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 ADAMS ST
Mailing Address - Street 2:APT A
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-4446
Mailing Address - Country:US
Mailing Address - Phone:508-259-9866
Mailing Address - Fax:
Practice Address - Street 1:12 ROGERS RD
Practice Address - Street 2:
Practice Address - City:WARD HILL
Practice Address - State:MA
Practice Address - Zip Code:01835-6947
Practice Address - Country:US
Practice Address - Phone:978-374-7971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6838235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist