Provider Demographics
NPI:1831512599
Name:ECKELKAMP, AMANDA ELISE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:ELISE
Last Name:ECKELKAMP
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 EAST SPRINGFIELD
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:MO
Mailing Address - Zip Code:63084
Mailing Address - Country:US
Mailing Address - Phone:636-583-3152
Mailing Address - Fax:
Practice Address - Street 1:2 E SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:MO
Practice Address - Zip Code:63084-1840
Practice Address - Country:US
Practice Address - Phone:636-583-3152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-30
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011021973235Z00000X
TX109735235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist