Provider Demographics
NPI:1265811319
Name:KERRIGAN, AMANDA (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:KERRIGAN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 HOLIDAY CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29206-1020
Mailing Address - Country:US
Mailing Address - Phone:908-433-4644
Mailing Address - Fax:
Practice Address - Street 1:5175 SUNSET BLVD
Practice Address - Street 2:SUITE M
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-7319
Practice Address - Country:US
Practice Address - Phone:803-586-1016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-22
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5699235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist