Provider Demographics
NPI:1639540438
Name:HENDRICK, AMANDA MCGUIRE (MS)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:MCGUIRE
Last Name:HENDRICK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MRS
Other - First Name:MIA
Other - Middle Name:
Other - Last Name:HENDRICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:712 S HOWARD AVE
Mailing Address - Street 2:APARTMENT 340
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2430
Mailing Address - Country:US
Mailing Address - Phone:734-223-2467
Mailing Address - Fax:
Practice Address - Street 1:6152 DELANCEY STATION ST
Practice Address - Street 2:SUITE 205
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-4206
Practice Address - Country:US
Practice Address - Phone:813-767-0763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ7311235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist