Provider Demographics
NPI:1669815031
Name:LAVALLE, AMANDA MICHELLE (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MICHELLE
Last Name:LAVALLE
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:MICHELLE
Other - Last Name:NESBITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:105 WILLOUGHBY CT
Mailing Address - Street 2:
Mailing Address - City:VENETIA
Mailing Address - State:PA
Mailing Address - Zip Code:15367-1459
Mailing Address - Country:US
Mailing Address - Phone:717-330-5596
Mailing Address - Fax:
Practice Address - Street 1:105 WILLOUGHBY CT
Practice Address - Street 2:
Practice Address - City:VENETIA
Practice Address - State:PA
Practice Address - Zip Code:15367-1459
Practice Address - Country:US
Practice Address - Phone:717-330-5596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-16
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL011919235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty