Provider Demographics
NPI:1710118971
Name:DEXTER, AMANDA MARIE ORR (MA,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:MARIE ORR
Last Name:DEXTER
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:MARIE ORR
Other - Last Name:DEXTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 300
Mailing Address - Street 2:
Mailing Address - City:NORTH GREECE
Mailing Address - State:NY
Mailing Address - Zip Code:14515-0300
Mailing Address - Country:US
Mailing Address - Phone:585-233-6003
Mailing Address - Fax:
Practice Address - Street 1:800 TAIT AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14616-2309
Practice Address - Country:US
Practice Address - Phone:585-233-6003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-05
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017604-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist