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General NPI Number Information
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NPI Number | 1912551904
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Entity Type | Individual
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Provider Name | AMANDA MELE AHSOON
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Gender | Female
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Dates
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Enumeration Date | 07/28/2019
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Last Update Date | 11/01/2020
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Provider Practice Location Address
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Address Line | 12727 NORTHUP WAY STE 1
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City | BELLEVUE
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State | WA
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Zip | 98005-1917
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Country | US
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Telephone | 425-533-5402
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Fax |
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Provider Business Mailing Address
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Address Line | 412 BROADWAY APT 611
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City | SEATTLE
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State | WA
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Zip | 98122-5585
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Country | US
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Telephone | 714-277-9394
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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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 |
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License Number State | WA
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