Provider Demographics
NPI:1780956516
Name:MCKINNEY, AMANDA (SLP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5235 CALYX LN
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-2214
Mailing Address - Country:US
Mailing Address - Phone:877-813-9090
Mailing Address - Fax:
Practice Address - Street 1:5235 CALYX LN
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-2214
Practice Address - Country:US
Practice Address - Phone:877-813-9090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP. 9988235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist