Provider Demographics
NPI:1851733687
Name:REID, AMANDA DURON (CCC, SLP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:DURON
Last Name:REID
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 1:6610 INTERSTATE 35 N
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76705-1136
Mailing Address - Country:US
Mailing Address - Phone:254-235-7604
Mailing Address - Fax:254-235-7612
Practice Address - Street 1:6610 INTERSTATE 35 N
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76705-1136
Practice Address - Country:US
Practice Address - Phone:254-235-7604
Practice Address - Fax:254-235-7612
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105024235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX12119811OtherASHA
TX62115OtherTSHA