MEDICARE: MS. AMANDA EDMONDSON MS, CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	KY-3173	KY
2	235Z00000X	Speech-Language Pathologist	22004360A	IN

General Provider Information

NPI Number	:	1205992799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMANDA EDMONDSON MS, CCC-SLP

Provider Business Mailing Address
First Line	:	326 OAK GROVE RD
Second Line	:
City	:	MILTON
State	:	KY
Zip	:	40045-1550
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 SHEPHERD LN
Second Line	:
City	:	BEDFORD
State	:	KY
Zip	:	40006-8809
Country	:	US
Telephone Number	:	502-255-3244
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	07/08/2007

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Directions to “ MS. AMANDA EDMONDSON MS, CCC-SLP” Practice Location

Language	Start Address	Practice Location

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