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General NPI Number Information
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NPI Number | 1275232100
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Entity Type | Individual
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Provider Name | AMANDA HENRIQUES
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Gender | Female
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Dates
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Enumeration Date | 02/28/2023
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Last Update Date | 02/28/2023
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Provider Practice Location Address
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Address Line | 16255 VENTURA BLVD STE 1015
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City | ENCINO
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State | CA
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Zip | 91436-2318
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Country | US
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Telephone | 818-741-7014
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Fax |
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Provider Business Mailing Address
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Address Line | 405 W ELK AVE APT 3
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City | GLENDALE
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State | CA
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Zip | 91204-1521
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Country | US
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Telephone | 310-872-0508
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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 | 30383
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License Number State | CA
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