Provider Demographics
NPI:1316123474
Name:ELKINS, AMANDA LEWIS (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEWIS
Last Name:ELKINS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 PINEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:WALTERBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29488-3640
Mailing Address - Country:US
Mailing Address - Phone:843-782-3662
Mailing Address - Fax:
Practice Address - Street 1:120 PINEWOOD ST
Practice Address - Street 2:
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488-3640
Practice Address - Country:US
Practice Address - Phone:843-782-3662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-18
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3990235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist