MEDICARE: AMANDA SOPER 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	07182	MD

General Provider Information

NPI Number	:	1538563184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA SOPER MS, CCC-SLP

Provider Business Mailing Address
First Line	:	1608 E WEST HWY 245
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910
Country	:	US
Telephone Number	:	201-960-2435
Fax Number	:

Provider Business Practice Location Address
First Line	:	1608 E WEST HWY APT 245
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-3012
Country	:	US
Telephone Number	:	201-960-2435
Fax Number	:

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

Provider Enumeration Date	:	10/10/2014
Last Update Date	:	11/25/2015

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