Healthcare Provider Details

I. General information

NPI: 1629463377
Provider Name (Legal Business Name): AMANDA PENNINGTON MA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2015
Last Update Date: 09/06/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1819 S WAGNER RD
ANN ARBOR MI
48103-9715
US

IV. Provider business mailing address

108 E HENRY ST APT 806
SALINE MI
48176-1754
US

V. Phone/Fax

Practice location:
  • Phone: 734-994-8100
  • Fax:
Mailing address:
  • Phone: 616-520-1991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101002356
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: