Provider Demographics
NPI:1013080514
Name:ZITO GRIFFIN, AMANDA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:ZITO GRIFFIN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5825 GLENRIDGE DR NE
Mailing Address - Street 2:BLDG 1, SUITE 133
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5387
Mailing Address - Country:US
Mailing Address - Phone:404-513-3810
Mailing Address - Fax:404-902-5440
Practice Address - Street 1:5825 GLENRIDGE DR NE
Practice Address - Street 2:BLDG 1, SUITE 133
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5387
Practice Address - Country:US
Practice Address - Phone:404-513-3810
Practice Address - Fax:404-902-5440
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117884235Z00000X
GASLP005916235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA910672577BMedicaid