Provider Demographics
NPI:1306900915
Name:WHITE, AMANDA MARIE (MS CCC SLP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:WHITE
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 1:90 N EAST ST
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-1170
Mailing Address - Country:US
Mailing Address - Phone:614-833-2111
Mailing Address - Fax:
Practice Address - Street 1:90 N EAST ST
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-1170
Practice Address - Country:US
Practice Address - Phone:614-833-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146007836235Z00000X
OH5559771235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist