Provider Demographics
NPI:1215682745
Name:HEREFORD, AMANDA POTTER (SLP)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:POTTER
Last Name:HEREFORD
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:FRANCES
Other - Last Name:POTTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:1215 21ST AVEUNUE SOUTH
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37232-8590
Mailing Address - Country:US
Mailing Address - Phone:615-343-1540
Mailing Address - Fax:615-936-1565
Practice Address - Street 1:1215 21ST AVEUNUE SOUTH SUITE 9211
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-0001
Practice Address - Country:US
Practice Address - Phone:615-343-1540
Practice Address - Fax:615-936-1565
Is Sole Proprietor?:No
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3201235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist