Provider Demographics
NPI:1154553576
Name:HENNINGER, AMANDA DIANE (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:DIANE
Last Name:HENNINGER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MRS
Other - First Name:AMANDA
Other - Middle Name:DIANE
Other - Last Name:WARREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:342 BOWERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-2734
Mailing Address - Country:US
Mailing Address - Phone:859-200-9563
Mailing Address - Fax:
Practice Address - Street 1:342 BOWERWOOD DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2734
Practice Address - Country:US
Practice Address - Phone:859-200-9563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3630235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist