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General NPI Number Information
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NPI Number | 1477936276
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Entity Type | Individual
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Provider Name | AMANDA A MILLEVILLE SLP
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Gender | Female
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Dates
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Enumeration Date | 06/30/2015
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Last Update Date | 10/03/2016
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Provider Practice Location Address
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Address Line | 74 YANK ST
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City | COURTDALE
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State | PA
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Zip | 18704-1136
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Country | US
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Telephone | 317-726-7534
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Fax |
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Provider Business Mailing Address
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Address Line | 74 YANK ST
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City | COURTDALE
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State | PA
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Zip | 18704-1136
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Country | US
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Telephone | 317-726-7534
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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 | 110147
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License Number State | TX
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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 | SL013139
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SLP009023
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License Number State | GA
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