Provider Demographics
NPI:1750634945
Name:WEBER, AMANDA (CCC SLP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:WEBER
Suffix:
Gender:F
Credentials:CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 2ND ST STE 307
Mailing Address - Street 2:
Mailing Address - City:SHALIMAR
Mailing Address - State:FL
Mailing Address - Zip Code:32579-1764
Mailing Address - Country:US
Mailing Address - Phone:850-862-7227
Mailing Address - Fax:850-862-2421
Practice Address - Street 1:60 2ND ST STE 307
Practice Address - Street 2:
Practice Address - City:SHALIMAR
Practice Address - State:FL
Practice Address - Zip Code:32579-1764
Practice Address - Country:US
Practice Address - Phone:850-862-7227
Practice Address - Fax:850-862-2421
Is Sole Proprietor?:No
Enumeration Date:2012-10-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist