NPI | 1265089916 |
---|---|
Former Name | AMANDA SMITH |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: FL 19776) |
Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: MO 2019026437) |
Enumeration Date | 2019-08-19 |
Last Update Date | 2022-12-13 |