Provider Demographics
NPI:1023419983
Name:MORALES, AMANDA
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:MORALES
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 1:135 AVE MUNOZ RIVERA E
Mailing Address - Street 2:E-SUITE 2
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627-2630
Mailing Address - Country:US
Mailing Address - Phone:787-568-9915
Mailing Address - Fax:
Practice Address - Street 1:135 AVE MUNOZ RIVERA E
Practice Address - Street 2:E-SUITE 2
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627-2630
Practice Address - Country:US
Practice Address - Phone:787-568-9915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1056235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1056OtherLICENSE