Provider Demographics
NPI:1386891307
Name:COCO, AMANDA MYCHALE
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:MYCHALE
Last Name:COCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S GILES AVE
Mailing Address - Street 2:
Mailing Address - City:GENTRY
Mailing Address - State:AR
Mailing Address - Zip Code:72734-9320
Mailing Address - Country:US
Mailing Address - Phone:479-736-2253
Mailing Address - Fax:
Practice Address - Street 1:781 W PICKENS RD
Practice Address - Street 2:
Practice Address - City:PEA RIDGE
Practice Address - State:AR
Practice Address - Zip Code:72751-2519
Practice Address - Country:US
Practice Address - Phone:479-451-8181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist