Provider Demographics
NPI:1427462423
Name:BALL, AMANDA L (MS)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:L
Last Name:BALL
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 1:4116 47TH AVE
Mailing Address - Street 2:APT. 1F
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-3055
Mailing Address - Country:US
Mailing Address - Phone:580-695-6188
Mailing Address - Fax:
Practice Address - Street 1:4116 47TH AVE
Practice Address - Street 2:APT. 1F
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-3055
Practice Address - Country:US
Practice Address - Phone:580-695-6188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021665-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist