Provider Demographics
NPI:1902225550
Name:RUSSO, AMANDA D (SLP)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:D
Last Name:RUSSO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:D
Other - Last Name:LITKENHAUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:1235 N RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306
Mailing Address - Country:US
Mailing Address - Phone:718-309-2035
Mailing Address - Fax:
Practice Address - Street 1:283 ADAMS ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201
Practice Address - Country:US
Practice Address - Phone:718-858-1160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023644235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist