MEDICARE: ALICIA JO AMUNDSON 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	8347	MN

General Provider Information

NPI Number	:	1477709343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICIA JO AMUNDSON MS, CCC-SLP

Provider Business Mailing Address
First Line	:	1772 STEIGER LAKE LN
Second Line	:	PO BOX 34
City	:	VICTORIA
State	:	MN
Zip	:	55386-7723
Country	:	US
Telephone Number	:	952-443-9888
Fax Number	:

Provider Business Practice Location Address
First Line	:	1772 STEIGER LAKE LN
Second Line	:
City	:	VICTORIA
State	:	MN
Zip	:	55386-7723
Country	:	US
Telephone Number	:	952-443-9888
Fax Number	:

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

Provider Enumeration Date	:	08/12/2008
Last Update Date	:	01/27/2015

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