Provider Demographics
NPI:1700994480
Name:BLASZCZYNSKI, AMANDA MOORE (AUD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:MOORE
Last Name:BLASZCZYNSKI
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1399
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35902-1399
Mailing Address - Country:US
Mailing Address - Phone:256-543-8899
Mailing Address - Fax:256-543-8002
Practice Address - Street 1:417 S 4TH ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5212
Practice Address - Country:US
Practice Address - Phone:256-543-8899
Practice Address - Fax:256-543-8002
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL868A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051550822Medicaid
AL051509639OtherBLUE CROSS BLUE SHIELD
AL051550822Medicaid
AL051509639OtherBLUE CROSS BLUE SHIELD