Provider Demographics
NPI:1154760171
Name:FOX, AMANDA BOGEY (MS,CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:BOGEY
Last Name:FOX
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700B CROMWELL DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5852
Mailing Address - Country:US
Mailing Address - Phone:252-756-3099
Mailing Address - Fax:252-756-0667
Practice Address - Street 1:700B CROMWELL DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5852
Practice Address - Country:US
Practice Address - Phone:252-756-3099
Practice Address - Fax:252-756-0667
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8638235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC562047423Medicaid