Provider Demographics
NPI:1720649403
Name:GURROLA, AMANDA (MS)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:GURROLA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 N SCREENLAND DR # 202
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-3805
Mailing Address - Country:US
Mailing Address - Phone:831-713-9327
Mailing Address - Fax:
Practice Address - Street 1:147 E OLIVE AVE
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-3407
Practice Address - Country:US
Practice Address - Phone:626-355-1729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP30164235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist