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General NPI Number Information
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NPI Number | 1265531099
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Entity Type | Individual
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Provider Name | AMANDA RAE BAMMAN MS, CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 07/06/2016
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Provider Practice Location Address
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Address Line | 7305 N MILITARY TRL # 126 AUDIOLOGY AND SPEECH PATHOLOGY
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City | RIVIERA BEACH
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State | FL
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Zip | 33410-7417
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Country | US
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Telephone | 561-422-6238
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Fax | 561-422-8515
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Provider Business Mailing Address
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Address Line | 7305 N MILITARY TRL # 126 AUDIOLOGY AND SPEECH PATHOLOGY
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City | RIVIERA BEACH
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State | FL
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Zip | 33410-7417
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Country | US
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Telephone | 561-422-6238
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Fax | 561-422-8515
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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 | SA 9384
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP16235
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License Number State | CA
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