MEDICARE: AMANDA ZITO GRIFFIN M.S., CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	117884	TX
2	235Z00000X	Speech-Language Pathologist	SLP005916	GA

General Provider Information

NPI Number	:	1013080514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA ZITO GRIFFIN M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	5825 GLENRIDGE DR NE
Second Line	:	BLDG 1, SUITE 133
City	:	ATLANTA
State	:	GA
Zip	:	30328-5387
Country	:	US
Telephone Number	:	404-513-3810
Fax Number	:	404-902-5440

Provider Business Practice Location Address
First Line	:	5825 GLENRIDGE DR NE
Second Line	:	BLDG 1, SUITE 133
City	:	ATLANTA
State	:	GA
Zip	:	30328-5387
Country	:	US
Telephone Number	:	404-513-3810
Fax Number	:	404-902-5440

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	04/06/2021

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Directions to “ AMANDA ZITO GRIFFIN M.S., CCC-SLP” Practice Location

Language	Start Address	Practice Location

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