Provider Demographics
NPI:1669739900
Name:TECH, AMANDA MARIE (MS, CCC- SLP)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:MARIE
Last Name:TECH
Suffix:
Gender:F
Credentials:MS, CCC- SLP
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:MARIE
Other - Last Name:SALLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CF-SLP
Mailing Address - Street 1:10130 SUGAR CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-1688
Mailing Address - Country:US
Mailing Address - Phone:850-712-0570
Mailing Address - Fax:
Practice Address - Street 1:10130 SUGAR CREEK CIR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-1688
Practice Address - Country:US
Practice Address - Phone:850-712-0570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP009604235Z00000X
FLSZ5421235Z00000X
FLSA11900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist