Provider Demographics
NPI:1487064010
Name:NIELSEN, AMANDA ELIZABETH (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:ELIZABETH
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:MA 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 65
Mailing Address - Street 2:
Mailing Address - City:ROARING RIVER
Mailing Address - State:NC
Mailing Address - Zip Code:28669-0065
Mailing Address - Country:US
Mailing Address - Phone:440-897-2096
Mailing Address - Fax:336-450-1929
Practice Address - Street 1:803 MOUNTAIN SCENERY RD
Practice Address - Street 2:
Practice Address - City:ROARING RIVER
Practice Address - State:NC
Practice Address - Zip Code:28669-8096
Practice Address - Country:US
Practice Address - Phone:440-897-2096
Practice Address - Fax:336-450-1929
Is Sole Proprietor?:No
Enumeration Date:2014-05-05
Last Update Date:2024-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10831235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist