Provider Demographics
NPI:1710459987
Name:MYERS, AMANDA KAYE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:KAYE
Last Name:MYERS
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 1:2750 NE ILER ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-1904
Mailing Address - Country:US
Mailing Address - Phone:406-671-5737
Mailing Address - Fax:
Practice Address - Street 1:2750 NE ILER ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-1904
Practice Address - Country:US
Practice Address - Phone:406-671-5737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-27
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15761235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist