Provider Demographics
NPI:1710236013
Name:BAKHASH, AMANDA KATE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:KATE
Last Name:BAKHASH
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 INDIAN DR
Mailing Address - Street 2:
Mailing Address - City:WOODCLIFF LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07677-8119
Mailing Address - Country:US
Mailing Address - Phone:201-704-8469
Mailing Address - Fax:
Practice Address - Street 1:71 INDIAN DR
Practice Address - Street 2:
Practice Address - City:WOODCLIFF LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07677-8119
Practice Address - Country:US
Practice Address - Phone:201-704-8469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-31
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00833900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist