Provider Demographics
NPI:1841638673
Name:BUCHHEIT, AMANDA MARIE (CLINSCID)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:BUCHHEIT
Suffix:
Gender:F
Credentials:CLINSCID
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 S OAKS AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-4741
Mailing Address - Country:US
Mailing Address - Phone:562-882-0909
Mailing Address - Fax:714-521-7523
Practice Address - Street 1:1 TIDEWATER CV
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-1661
Practice Address - Country:US
Practice Address - Phone:562-882-0909
Practice Address - Fax:714-521-7523
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-14
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
CA17998235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty