Provider Demographics
NPI:1801109129
Name:NITSCHKE, AMANDA LOUISE (BA, MS)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:LOUISE
Last Name:NITSCHKE
Suffix:
Gender:F
Credentials:BA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4107 MEDICAL PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-3729
Mailing Address - Country:US
Mailing Address - Phone:512-573-7486
Mailing Address - Fax:
Practice Address - Street 1:4107 MEDICAL PKWY STE 200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-3729
Practice Address - Country:US
Practice Address - Phone:512-573-7486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-15
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100867235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist