Provider Demographics
NPI:1457792889
Name:LONG, AMANDA WEAVER (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:WEAVER
Last Name:LONG
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1780 SUNFLOWER CIR
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-8193
Mailing Address - Country:US
Mailing Address - Phone:828-273-3119
Mailing Address - Fax:
Practice Address - Street 1:1780 SUNFLOWER CIR
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-8193
Practice Address - Country:US
Practice Address - Phone:828-273-3119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-15
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist