MEDICARE: MRS. AMANDA SKILLING CRANE 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	SLP006892	GA

General Provider Information

NPI Number	:	1619249117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMANDA SKILLING CRANE SLP

Provider Business Mailing Address
First Line	:	PO BOX 589
Second Line	:
City	:	ROYSTON
State	:	GA
Zip	:	30662-0589
Country	:	US
Telephone Number	:	706-245-1822
Fax Number	:	706-245-1854

Provider Business Practice Location Address
First Line	:	613 COOK ST
Second Line	:
City	:	ROYSTON
State	:	GA
Zip	:	30662-3933
Country	:	US
Telephone Number	:	706-245-1822
Fax Number	:	706-245-1854

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

Provider Enumeration Date	:	01/31/2012
Last Update Date	:	01/31/2012

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