Healthcare Provider Details

I. General information

NPI: 1396186474
Provider Name (Legal Business Name): AMANDA L GARRISON MS CCC/SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2013
Last Update Date: 06/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 S SONCY RD STE 137
AMARILLO TX
79119
US

IV. Provider business mailing address

3501 S SONCY RD STE 137
AMARILLO TX
79119-6406
US

V. Phone/Fax

Practice location:
  • Phone: 806-331-6084
  • Fax: 806-331-6085
Mailing address:
  • Phone: 806-331-8064
  • Fax: 806-331-8065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number103273
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: