Provider Demographics
NPI:1336300946
Name:SHINALL, AMANDA RUTH (MS)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:RUTH
Last Name:SHINALL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13931 SIERRA STAR CT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-2976
Mailing Address - Country:US
Mailing Address - Phone:719-283-1406
Mailing Address - Fax:719-249-5834
Practice Address - Street 1:13931 SIERRA STAR CT
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80921-2976
Practice Address - Country:US
Practice Address - Phone:719-283-1406
Practice Address - Fax:719-249-5834
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORBT-23-259720106S00000X
231H00000X
CO1-24-75915103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist