Provider Demographics
NPI:1427483635
Name:RECKER, AMANDA KAY (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:KAY
Last Name:RECKER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 152
Mailing Address - Street 2:
Mailing Address - City:KALIDA
Mailing Address - State:OH
Mailing Address - Zip Code:45853-0152
Mailing Address - Country:US
Mailing Address - Phone:419-796-0386
Mailing Address - Fax:
Practice Address - Street 1:1331 E 4TH ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:OH
Practice Address - Zip Code:45875-1505
Practice Address - Country:US
Practice Address - Phone:419-523-9337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-06
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH9632235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist