Provider Demographics
NPI:1942984935
Name:SHUBERT, AMANDA-KAY (SLP)
Entity Type:Individual
Prefix:
First Name:AMANDA-KAY
Middle Name:
Last Name:SHUBERT
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-3313
Mailing Address - Country:US
Mailing Address - Phone:769-926-2441
Mailing Address - Fax:769-926-2442
Practice Address - Street 1:317 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-3313
Practice Address - Country:US
Practice Address - Phone:769-926-2441
Practice Address - Fax:769-926-2442
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS-5069235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist