Provider Demographics
NPI:1285893024
Name:MORRISSEY, AMANDA LEE (PHD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEE
Last Name:MORRISSEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:MARESJO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1155 MILL STREET
Mailing Address - Street 2:MS M-14
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1576
Mailing Address - Country:US
Mailing Address - Phone:775-982-5262
Mailing Address - Fax:775-982-8020
Practice Address - Street 1:1664 N VIRGINIA ST
Practice Address - Street 2:MS-0152
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89557-0152
Practice Address - Country:US
Practice Address - Phone:775-784-4887
Practice Address - Fax:775-784-4095
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-1198235Z00000X
WALL60343656235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1285893024Medicaid