Provider Demographics
NPI:1851596977
Name:ACEVEDO, AMANDA (SLP-A)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:ACEVEDO
Suffix:
Gender:F
Credentials:SLP-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14448 N IBSEN DR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-2921
Mailing Address - Country:US
Mailing Address - Phone:602-531-0876
Mailing Address - Fax:
Practice Address - Street 1:14448 N IBSEN DR
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-2921
Practice Address - Country:US
Practice Address - Phone:602-531-0876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTHL6312355S0801X
AZSLPA 67902355S0801X
AZSLPL66532355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant