Healthcare Provider Details

I. General information

NPI: 1013466614
Provider Name (Legal Business Name): AMANDA PENDLEY M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2016
Last Update Date: 09/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 GRAND OAKS CT
ALVORD TX
76225-6020
US

IV. Provider business mailing address

605 GRAND OAKS CT
ALVORD TX
76225-6020
US

V. Phone/Fax

Practice location:
  • Phone: 940-577-4550
  • Fax: 940-427-2315
Mailing address:
  • Phone: 940-577-4550
  • Fax: 940-427-2315

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: