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NPI Code Detail

MEDICARE: MISS AMANDA GOSSETT SLP

MEDICARE: MISS AMANDA GOSSETT 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
1235Z00000XSpeech-Language PathologistSP1134NV

General Provider Information

NPI Number : 1932313731
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS AMANDA GOSSETT SLP
Provider Business Mailing Address
First Line : 1900 RIO CANYON CT APT 104
Second Line :
City : LAS VEGAS
State : NV
Zip : 89128-2705
Country : US
Telephone Number : 260-433-1076
Fax Number :
Provider Business Practice Location Address
First Line : 2626 SAINT JOE CENTER RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46825-5042
Country : US
Telephone Number : 260-497-0328
Fax Number : 260-749-7090
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2007
Last Update Date : 06/21/2021

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Directions to “ MISS AMANDA GOSSETT SLP” Practice Location

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