Provider Demographics
NPI:1295952547
Name:BEAVERS, AMANDA LEIGH (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:LEIGH
Last Name:BEAVERS
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 1:5928 MONTPELIER DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-8122
Mailing Address - Country:US
Mailing Address - Phone:757-345-3329
Mailing Address - Fax:
Practice Address - Street 1:1769 JAMESTOWN RD
Practice Address - Street 2:SUITE 103
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-2324
Practice Address - Country:US
Practice Address - Phone:757-229-2516
Practice Address - Fax:757-565-1738
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202004986235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist