Provider Demographics
NPI:1265899231
Name:MCKINNEY, AMANDA SUZANNE (MS, CCC/SLP)
Entity type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:SUZANNE
Last Name:MCKINNEY
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 1:474 MULBERRY ST APT C
Mailing Address - Street 2:
Mailing Address - City:LEITCHFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42754-2253
Mailing Address - Country:US
Mailing Address - Phone:270-589-9058
Mailing Address - Fax:
Practice Address - Street 1:11902 OAK BAY PL
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-6476
Practice Address - Country:US
Practice Address - Phone:502-550-2525
Practice Address - Fax:187-721-2252
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3726235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist