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General NPI Number Information
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NPI Number | 1972014470
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Entity Type | Organization
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Legal Business Name | AMANDA GEAN SPEECH-LANGUAGE PATHOLOGY, INC
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Dates
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Enumeration Date | 10/24/2017
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Last Update Date | 10/24/2017
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Provider Practice Location Address
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Address Line | 230 GRAND AVE
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City | OAKLAND
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State | CA
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Zip | 94610-4589
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Country | US
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Telephone | 415-238-8418
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Fax |
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Provider Business Mailing Address
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Address Line | 2290 LEIMERT BLVD
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City | OAKLAND
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State | CA
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Zip | 94602-1944
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Country | US
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Telephone | 415-238-8418
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | AMANDA GEAN
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Credential |
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Telephone | 415-238-8418
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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 | 17273
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License Number State | CA
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