Provider Demographics
NPI:1316221609
Name:ROCHE, AMANDA L (CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:L
Last Name:ROCHE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 WASHINGTON AVE
Mailing Address - Street 2:PROSPECT HILL ELEMENTARY SCHOOL
Mailing Address - City:PELHAM
Mailing Address - State:NY
Mailing Address - Zip Code:10803-3744
Mailing Address - Country:US
Mailing Address - Phone:914-738-6690
Mailing Address - Fax:
Practice Address - Street 1:1000 WASHINGTON AVE
Practice Address - Street 2:PROSPECT HILL ELEMENTARY SCHOOL
Practice Address - City:PELHAM
Practice Address - State:NY
Practice Address - Zip Code:10803-3220
Practice Address - Country:US
Practice Address - Phone:914-738-6690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020187-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist