MEDICARE: MISS AMANDA C ROBLES MS, 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	34623	CA

General Provider Information

NPI Number	:	1114633575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS AMANDA C ROBLES MS, CCC-SLP

Provider Business Mailing Address
First Line	:	328 N 6TH AVE APT C
Second Line	:
City	:	UPLAND
State	:	CA
Zip	:	91786-5307
Country	:	US
Telephone Number	:	909-285-4578
Fax Number	:

Provider Business Practice Location Address
First Line	:	328 N 6TH AVE APT C
Second Line	:
City	:	UPLAND
State	:	CA
Zip	:	91786-5307
Country	:	US
Telephone Number	:	559-599-5647
Fax Number	:

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

Provider Enumeration Date	:	01/27/2023
Last Update Date	:	04/17/2025

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