Provider Demographics
NPI:1265531099
Name:BAMMAN, AMANDA RAE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:RAE
Last Name:BAMMAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
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Mailing Address - Street 1:7305 N MILITARY TRL # 126
Mailing Address - Street 2:AUDIOLOGY AND SPEECH PATHOLOGY
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33410-7417
Mailing Address - Country:US
Mailing Address - Phone:561-422-6238
Mailing Address - Fax:561-422-8515
Practice Address - Street 1:7305 N MILITARY TRL # 126
Practice Address - Street 2:AUDIOLOGY AND SPEECH PATHOLOGY
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33410-7417
Practice Address - Country:US
Practice Address - Phone:561-422-6238
Practice Address - Fax:561-422-8515
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLSA 9384235Z00000X
CASP16235235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist