Provider Demographics
NPI:1982301586
Name:BRASTAD, AMANDA (CF SLP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:BRASTAD
Suffix:
Gender:F
Credentials:CF SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5-11 SADDLE RIVER RD STE 2A
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-5636
Mailing Address - Country:US
Mailing Address - Phone:551-579-0465
Mailing Address - Fax:
Practice Address - Street 1:5-11 SADDLE RIVER RD STE 2A
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-5636
Practice Address - Country:US
Practice Address - Phone:551-579-0465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTL-3944235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist