Provider Demographics
NPI:1750613576
Name:MARSALIS, AMANDA K (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:K
Last Name:MARSALIS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:K
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:10301 N 70TH ST UNIT 206
Mailing Address - Street 2:
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-1459
Mailing Address - Country:US
Mailing Address - Phone:602-791-4290
Mailing Address - Fax:
Practice Address - Street 1:10301 N 70TH ST UNIT 206
Practice Address - Street 2:
Practice Address - City:PARADISE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85253-1459
Practice Address - Country:US
Practice Address - Phone:602-791-4290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-03
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5779235Z00000X
AZTSLP5779235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist