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General NPI Number Information
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NPI Number | 1891342655
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Entity Type | Individual
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Provider Name | AMANDA KAY GAMMILL M.S CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 08/26/2019
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Last Update Date | 08/26/2019
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Provider Practice Location Address
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Address Line | 9401 E 161ST ST S
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City | BIXBY
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State | OK
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Zip | 74008-5093
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Country | US
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Telephone | 918-366-2249
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Fax |
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Provider Business Mailing Address
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Address Line | 19420 S YALE AVE
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City | MOUNDS
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State | OK
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Zip | 74047-5113
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Country | US
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Telephone | 918-207-6342
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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 | 14069119
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License Number State | OK
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