Provider Demographics
NPI:1932313731
Name:GOSSETT, AMANDA (SLP)
Entity Type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:
Last Name:GOSSETT
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:RUPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1900 RIO CANYON CT APT 104
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-2705
Mailing Address - Country:US
Mailing Address - Phone:260-433-1076
Mailing Address - Fax:
Practice Address - Street 1:2626 SAINT JOE CENTER RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-5042
Practice Address - Country:US
Practice Address - Phone:260-497-0328
Practice Address - Fax:260-749-7090
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP1134235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist