MEDICARE: AMANDA CASAS M.S. 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	116169	TX

General Provider Information

NPI Number	:	1821713850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA CASAS M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	4309 SPINDLETREE LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-1151
Country	:	US
Telephone Number	:	956-560-5681
Fax Number	:

Provider Business Practice Location Address
First Line	:	6000 KEENELAND PKWY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75211-6930
Country	:	US
Telephone Number	:	972-794-4600
Fax Number	:

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

Provider Enumeration Date	:	10/12/2022
Last Update Date	:	10/12/2022

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