Provider Demographics
NPI:1487878898
Name:KING, AMANDA LEE (MS, SLP-CCC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEE
Last Name:KING
Suffix:
Gender:F
Credentials:MS, SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 UNION BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1835
Mailing Address - Country:US
Mailing Address - Phone:720-583-6348
Mailing Address - Fax:303-362-8986
Practice Address - Street 1:2851 S PARKER RD STE 570
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-2749
Practice Address - Country:US
Practice Address - Phone:303-888-4840
Practice Address - Fax:303-888-4840
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12102075235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO841465539Medicaid
CO841465539Medicaid