MEDICARE: AMANDA GREEN 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	SP2975	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14033060	OTHER	AR	ASHA

General Provider Information

NPI Number	:	1497294409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA GREEN SLP

Provider Business Mailing Address
First Line	:	922 E BOBE ST
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32503-3962
Country	:	US
Telephone Number	:	850-741-6715
Fax Number	:	850-204-0489

Provider Business Practice Location Address
First Line	:	7830 PINE FOREST RD
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32526-8404
Country	:	US
Telephone Number	:	850-741-6715
Fax Number	:	850-204-0489

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

Provider Enumeration Date	:	02/23/2017
Last Update Date	:	11/21/2022

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Directions to “ AMANDA GREEN SLP” Practice Location

Language	Start Address	Practice Location

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