Provider Demographics
NPI:1720687072
Name:MUELLER, AMANDA LUCILLE (AUD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LUCILLE
Last Name:MUELLER
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 1:1170 ROYAL AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-6101
Mailing Address - Country:US
Mailing Address - Phone:541-779-7331
Mailing Address - Fax:541-779-3522
Practice Address - Street 1:1170 ROYAL AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6101
Practice Address - Country:US
Practice Address - Phone:541-779-7331
Practice Address - Fax:541-779-3522
Is Sole Proprietor?:No
Enumeration Date:2020-10-19
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR30983237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter