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General NPI Number Information
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NPI Number | 1487064010
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Entity Type | Individual
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Provider Name | AMANDA ELIZABETH NIELSEN M.A. CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 05/05/2014
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Last Update Date | 12/08/2024
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Provider Practice Location Address
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Address Line | 803 MOUNTAIN SCENERY RD
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City | ROARING RIVER
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State | NC
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Zip | 28669-8096
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Country | US
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Telephone | 440-897-2096
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Fax | 336-450-1929
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Provider Business Mailing Address
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Address Line | PO BOX 65
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City | ROARING RIVER
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State | NC
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Zip | 28669-0065
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Country | US
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Telephone | 440-897-2096
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Fax | 336-450-1929
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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 | 10831
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License Number State | NC
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