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General NPI Number Information
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NPI Number | 1053886101
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Entity Type | Individual
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Provider Name | AMANDA ZACHARY CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 10/04/2018
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Last Update Date | 10/04/2018
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Provider Practice Location Address
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Address Line | 4400 WALNUT ST
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City | GREENVILLE
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State | TX
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Zip | 75401-5586
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Country | US
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Telephone | 903-455-8729
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Fax |
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Provider Business Mailing Address
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Address Line | 5402 SAYLE ST APT 167
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City | GREENVILLE
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State | TX
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Zip | 75402-6323
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Country | US
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Telephone | 281-222-9575
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 111705
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License Number State | TX
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