Healthcare Provider Details

I. General information

NPI: 1568381812
Provider Name (Legal Business Name): AMANDA ELLEN BANACH MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7630 S 10TH ST
OAK CREEK WI
53154-1912
US

IV. Provider business mailing address

9330 S SHEPARD AVE
OAK CREEK WI
53154-4548
US

V. Phone/Fax

Practice location:
  • Phone: 414-768-6260
  • Fax:
Mailing address:
  • Phone: 414-768-6260
  • 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: