Provider Demographics
NPI:1508745928
Name:LEVINE, AMANDA KAY (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:KAY
Last Name:LEVINE
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 1:11183 CLAYTON BLVD
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-2364
Mailing Address - Country:US
Mailing Address - Phone:919-243-2201
Mailing Address - Fax:
Practice Address - Street 1:11183 CLAYTON BLVD
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-2364
Practice Address - Country:US
Practice Address - Phone:919-243-2201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-29
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30003568235Z00000X
FLSA6959235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist