MEDICARE: AMANDA LYNN STEAD M.A.

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	5865	LA

General Provider Information

NPI Number	:	1679759591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA LYNN STEAD M.A.

Provider Business Mailing Address
First Line	:	3250 CARLOTTA ST
Second Line	:	APT. 6
City	:	BATON ROUGE
State	:	LA
Zip	:	70802-6903
Country	:	US
Telephone Number	:	225-329-7844
Fax Number	:

Provider Business Practice Location Address
First Line	:	3250 CARLOTTA ST
Second Line	:	APT. 6
City	:	BATON ROUGE
State	:	LA
Zip	:	70802-6903
Country	:	US
Telephone Number	:	225-329-7844
Fax Number	:

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

Provider Enumeration Date	:	01/10/2008
Last Update Date	:	01/10/2008

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