Healthcare Provider Details

I. General information

NPI: 1740667476
Provider Name (Legal Business Name): AMANDA LYN VERBLE M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMANDA LYN HOWELL M.A., CCC-SLP

II. Dates (important events)

Enumeration Date: 05/01/2015
Last Update Date: 02/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6867 SOUTHPOINT DR N
JACKSONVILLE FL
32216-8043
US

IV. Provider business mailing address

2919 FORBES ST
JACKSONVILLE FL
32205-7522
US

V. Phone/Fax

Practice location:
  • Phone: 904-619-6071
  • Fax:
Mailing address:
  • Phone: 904-316-5713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: