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General NPI Number Information
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NPI Number | 1740735158
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Entity Type | Individual
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Provider Name | AMANDA KROBOTH M.A. CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 08/16/2016
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Last Update Date | 09/27/2019
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Provider Practice Location Address
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Address Line | 16535 110TH AVE SE
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City | YELM
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State | WA
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Zip | 98597
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Country | US
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Telephone | 360-458-6194
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 FERN ST SW APT 25-101
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City | OLYMPIA
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State | WA
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Zip | 98502-1127
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Country | US
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Telephone | 484-547-4322
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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 | LL60686585
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License Number State | WA
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