Provider Demographics
NPI:1205475530
Name:SITREN, AMANDA E (CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:E
Last Name:SITREN
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 1:245 SUMNER ST APT 105
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128-2192
Mailing Address - Country:US
Mailing Address - Phone:732-512-7245
Mailing Address - Fax:
Practice Address - Street 1:25 PINEWOOD RD
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-4505
Practice Address - Country:US
Practice Address - Phone:732-512-7245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-03
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA77296235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty