Provider Demographics
NPI:1407576390
Name:SORENSEN, AMANDA SUMMER (MS CF-SLP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:SUMMER
Last Name:SORENSEN
Suffix:
Gender:F
Credentials:MS CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 ASPEN ST
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-3326
Mailing Address - Country:US
Mailing Address - Phone:210-334-5055
Mailing Address - Fax:
Practice Address - Street 1:4000 EAGLE PASS
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-4705
Practice Address - Country:US
Practice Address - Phone:469-752-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120146235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX23Medicaid