Provider Demographics
NPI:1205307782
Name:AUBRY, AMANDA SUZANNE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:SUZANNE
Last Name:AUBRY
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 1:5208 ARLINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:HANOVER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60133-5519
Mailing Address - Country:US
Mailing Address - Phone:630-894-4638
Mailing Address - Fax:
Practice Address - Street 1:5208 ARLINGTON CIR
Practice Address - Street 2:
Practice Address - City:HANOVER PARK
Practice Address - State:IL
Practice Address - Zip Code:60133-5519
Practice Address - Country:US
Practice Address - Phone:630-894-4638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-10
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.006829235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist