Provider Demographics
NPI:1427744515
Name:BRAWDERS, AMANDA GAYLE (HIS)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:GAYLE
Last Name:BRAWDERS
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:GAYLE
Other - Last Name:GARRISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:233 AZALEA ST
Mailing Address - Street 2:
Mailing Address - City:FILLMORE
Mailing Address - State:CA
Mailing Address - Zip Code:93015-2240
Mailing Address - Country:US
Mailing Address - Phone:805-901-8645
Mailing Address - Fax:
Practice Address - Street 1:3003 LOMA VISTA RD STE C
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2941
Practice Address - Country:US
Practice Address - Phone:805-648-1685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA8098237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist