Healthcare Provider Details

I. General information

NPI: 1861839805
Provider Name (Legal Business Name): AMANDA J SUMRALL M.S.,-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2013
Last Update Date: 11/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

634 PYRAMID WAY
SPARKS NV
89431
US

IV. Provider business mailing address

634 PYRAMID WAY
SPARKS NV
89431-5059
US

V. Phone/Fax

Practice location:
  • Phone: 775-336-0211
  • Fax: 775-336-0213
Mailing address:
  • Phone: 775-336-0211
  • Fax: 775-336-0213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number8624516-4102
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP-1364
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: