Provider Demographics
NPI:1952845646
Name:GEORGE, AMANDA
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:GEORGE
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 1:6291 ADMIRAL PEARY HWY
Mailing Address - Street 2:
Mailing Address - City:LORETTO
Mailing Address - State:PA
Mailing Address - Zip Code:15940-6506
Mailing Address - Country:US
Mailing Address - Phone:814-932-1954
Mailing Address - Fax:
Practice Address - Street 1:514 ORCHARD ST
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:PA
Practice Address - Zip Code:15946-1626
Practice Address - Country:US
Practice Address - Phone:814-421-2754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-14
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL010670235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist