Healthcare Provider Details

I. General information

NPI: 1598147605
Provider Name (Legal Business Name): AMANDA KENNEDY M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMANDA LINES MS CCC-SLP

II. Dates (important events)

Enumeration Date: 06/25/2015
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 ALDERGROVE AVE
ESCONDIDO CA
92029-1935
US

IV. Provider business mailing address

3507 CAMINITO SIERRA UNIT 304
CARLSBAD CA
92009-8676
US

V. Phone/Fax

Practice location:
  • Phone: 760-432-2400
  • Fax:
Mailing address:
  • Phone: 909-230-8117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP23645
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: