Provider Demographics
NPI:1619421443
Name:BENEDICK, AMANDA (SLP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:BENEDICK
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 1:1736 KATYLAND DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-1751
Mailing Address - Country:US
Mailing Address - Phone:281-237-2753
Mailing Address - Fax:281-644-1846
Practice Address - Street 1:1736 KATYLAND DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-1751
Practice Address - Country:US
Practice Address - Phone:281-237-2753
Practice Address - Fax:281-644-1846
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-10
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107152235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist