MEDICARE: MISS AMANDA ELIZABETH LEAVELL MS, SLP-INTERN

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

General Provider Information

NPI Number	:	1750019915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS AMANDA ELIZABETH LEAVELL MS, SLP-INTERN

Provider Business Mailing Address
First Line	:	3925 N ELM ST APT 1410
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76207-7133
Country	:	US
Telephone Number	:	940-435-1743
Fax Number	:

Provider Business Practice Location Address
First Line	:	2820 WIND RIVER LN
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76210-2993
Country	:	US
Telephone Number	:	940-448-8402
Fax Number	:

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

Provider Enumeration Date	:	08/15/2022
Last Update Date	:	08/15/2022

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Directions to “ MISS AMANDA ELIZABETH LEAVELL MS, SLP-INTERN” Practice Location

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