Provider Demographics
NPI:1013165646
Name:RICHETTA, AMANDA LEE (MA)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEE
Last Name:RICHETTA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:LOWER BURRELL
Mailing Address - State:PA
Mailing Address - Zip Code:15068-3113
Mailing Address - Country:US
Mailing Address - Phone:724-304-0030
Mailing Address - Fax:
Practice Address - Street 1:110 ALLEN ST
Practice Address - Street 2:
Practice Address - City:LOWER BURRELL
Practice Address - State:PA
Practice Address - Zip Code:15068-3113
Practice Address - Country:US
Practice Address - Phone:724-304-0030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL009291235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist