Provider Demographics
NPI:1457407538
Name:ROBINSON, AMANDA C (SLT, SLPA)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:C
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:SLT, SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17435 N 7TH ST
Mailing Address - Street 2:APT 2184
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-1904
Mailing Address - Country:US
Mailing Address - Phone:317-658-3069
Mailing Address - Fax:
Practice Address - Street 1:10002 N 7TH ST
Practice Address - Street 2:APT 1049
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-1751
Practice Address - Country:US
Practice Address - Phone:480-200-3292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPL5023235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist