MEDICARE: AMANDA IRENE GILLESPIE PHD, 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	SL008447	PA
2	235Z00000X	Speech-Language Pathologist	SLP010142	GA

General Provider Information

NPI Number	:	1619037488
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA IRENE GILLESPIE PHD, CCC-SLP

Provider Business Mailing Address
First Line	:	550 PEACHTREE ST NE STE 1135
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30308-2234
Country	:	US
Telephone Number	:	404-778-3381
Fax Number	:

Provider Business Practice Location Address
First Line	:	550 PEACHTREE ST NE STE 1135
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30308
Country	:	US
Telephone Number	:	404-778-3381
Fax Number	:

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

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	07/03/2018

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Directions to “ AMANDA IRENE GILLESPIE PHD, CCC-SLP” Practice Location

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