Provider Demographics
NPI:1972014470
Name:AMANDA GEAN SPEECH-LANGUAGE PATHOLOGY, INC
Entity Type:Organization
Organization Name:AMANDA GEAN SPEECH-LANGUAGE PATHOLOGY, INC
Other - Org Name:AMANDA GEAN SLP, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-238-8418
Mailing Address - Street 1:2290 LEIMERT BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-1944
Mailing Address - Country:US
Mailing Address - Phone:415-238-8418
Mailing Address - Fax:
Practice Address - Street 1:230 GRAND AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-4589
Practice Address - Country:US
Practice Address - Phone:415-238-8418
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17273235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty