Provider Demographics
NPI:1477341394
Name:MOXHAM, AMANDA EMMA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:EMMA
Last Name:MOXHAM
Suffix:
Gender:
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 1:1037 WASHINGTON ST APT 3
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-5238
Mailing Address - Country:US
Mailing Address - Phone:215-630-1673
Mailing Address - Fax:
Practice Address - Street 1:1037 WASHINGTON ST APT 3
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-5238
Practice Address - Country:US
Practice Address - Phone:215-630-1673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS01168400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty