Provider Demographics
NPI:1386958056
Name:BARCLAY, AMANDA (MS, CCC)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:BARCLAY
Suffix:
Gender:F
Credentials:MS, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10517 OCEAN HIGHWAY UNIT 4 PMB 111
Mailing Address - Street 2:
Mailing Address - City:PAWLEYS ISL
Mailing Address - State:SC
Mailing Address - Zip Code:29585-7655
Mailing Address - Country:US
Mailing Address - Phone:843-936-0020
Mailing Address - Fax:855-718-2654
Practice Address - Street 1:44 COTTAGE DR
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-7877
Practice Address - Country:US
Practice Address - Phone:843-936-0020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13639235Z00000X
AZ7719235Z00000X
SC6188235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACL809BOtherPTAN