Provider Demographics
NPI:1811235112
Name:SPINOGATTI, AMANDA IACONO
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:IACONO
Last Name:SPINOGATTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:ASTON
Mailing Address - State:PA
Mailing Address - Zip Code:19014-1931
Mailing Address - Country:US
Mailing Address - Phone:610-859-7833
Mailing Address - Fax:610-859-0367
Practice Address - Street 1:3200 CONCORD RD
Practice Address - Street 2:
Practice Address - City:ASTON
Practice Address - State:PA
Practice Address - Zip Code:19014-1931
Practice Address - Country:US
Practice Address - Phone:610-859-7833
Practice Address - Fax:610-859-0367
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-21
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL010652235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist