Provider Demographics
NPI:1184388928
Name:DOCK, AMANDA K (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:K
Last Name:DOCK
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2709 CARTER CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2422
Mailing Address - Country:US
Mailing Address - Phone:979-716-7573
Mailing Address - Fax:
Practice Address - Street 1:1201 RIDGEDALE ST
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77803-3722
Practice Address - Country:US
Practice Address - Phone:979-716-7573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108904235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist