Provider Demographics
NPI:1134173867
Name:STEPHENS, AMANDA LEWIS (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:LEWIS
Last Name:STEPHENS
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 1:12412 PACIFIC AVE
Mailing Address - Street 2:#3
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-4404
Mailing Address - Country:US
Mailing Address - Phone:562-826-5415
Mailing Address - Fax:
Practice Address - Street 1:5901 E 7TH ST
Practice Address - Street 2:S102
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90822-5201
Practice Address - Country:US
Practice Address - Phone:562-826-8000
Practice Address - Fax:562-826-5823
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13752235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist