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General NPI Number Information
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NPI Number | 1013163468
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Entity Type | Individual
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Provider Name | AMANDA LYNNE STALLINGS B.S.
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Gender | Female
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Dates
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Enumeration Date | 08/15/2008
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Last Update Date | 08/17/2008
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Provider Practice Location Address
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Address Line | 2208 FOWLER AVE
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City | JONESBORO
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State | AR
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Zip | 72401-6115
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Country | US
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Telephone | 870-913-0808
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Fax |
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Provider Business Mailing Address
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Address Line | 661 LAWERANCE 203
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City | IMBODEN
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State | AR
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Zip | 72434
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Country | US
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Telephone | 870-926-1889
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number | R# 09-001
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License Number State | AR
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