Provider Demographics
NPI:1922491281
Name:ROEBUCK, AMANDA MARGARET
Entity Type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:MARGARET
Last Name:ROEBUCK
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 1:3669 BRISCOE ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-1894
Mailing Address - Country:US
Mailing Address - Phone:951-662-3478
Mailing Address - Fax:
Practice Address - Street 1:3669 BRISCOE ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-1894
Practice Address - Country:US
Practice Address - Phone:951-662-3478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-11
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24242355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant