Provider Demographics
NPI:1780894675
Name:FERGUSON, AMANDA L (MT-BC, NMT)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:L
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:MT-BC, NMT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:BURKART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16410 S 12TH ST
Mailing Address - Street 2:# 109
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-4001
Mailing Address - Country:US
Mailing Address - Phone:602-478-0287
Mailing Address - Fax:480-659-1726
Practice Address - Street 1:2702 N 3RD ST
Practice Address - Street 2:SUITE 1000
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1130
Practice Address - Country:US
Practice Address - Phone:602-840-6410
Practice Address - Fax:602-840-6431
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist