Provider Demographics
NPI:1619372802
Name:GUTHRIE, AMANDA (MED CF-SLP)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:GUTHRIE
Suffix:
Gender:F
Credentials:MED CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 E G MILES PKWY
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-8072
Mailing Address - Country:US
Mailing Address - Phone:912-335-8486
Mailing Address - Fax:
Practice Address - Street 1:933 E G MILES PKWY
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-8072
Practice Address - Country:US
Practice Address - Phone:912-335-8486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-30
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCET002123235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist