Provider Demographics
NPI:1215100938
Name:NEWKIRK, AMANDA J (MS-CCC/SLP)
Entity type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:J
Last Name:NEWKIRK
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 1:634 N MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-3733
Mailing Address - Country:US
Mailing Address - Phone:618-632-4222
Mailing Address - Fax:
Practice Address - Street 1:634 N MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-3733
Practice Address - Country:US
Practice Address - Phone:618-632-4222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-03
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist