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NPI Code Detail

MEDICARE: AMANDA DAWN GLOVER MCD, CCC-SLP

MEDICARE: AMANDA DAWN GLOVER MCD, 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
1235Z00000XSpeech-Language Pathologist1967AR

General Provider Information

NPI Number : 1730223058
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA DAWN GLOVER MCD, CCC-SLP
Provider Business Mailing Address
First Line : 412 CHARLESTON CV
Second Line :
City : JONESBORO
State : AR
Zip : 72404-9153
Country : US
Telephone Number : 870-931-7274
Fax Number : 870-931-7274
Provider Business Practice Location Address
First Line : 3423 E HIGHLAND DR STE A
Second Line :
City : JONESBORO
State : AR
Zip : 72401-6404
Country : US
Telephone Number : 870-219-8289
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/19/2007
Last Update Date : 07/08/2007

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Directions to “ AMANDA DAWN GLOVER MCD, CCC-SLP” Practice Location

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