Provider Demographics
NPI:1538566302
Name:MIHALAK, AMANDA (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:MIHALAK
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 1:240 W 11TH ST
Mailing Address - Street 2:SUITE 402
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16501-1758
Mailing Address - Country:US
Mailing Address - Phone:814-464-0627
Mailing Address - Fax:814-464-0629
Practice Address - Street 1:240 W 11TH ST
Practice Address - Street 2:SUITE 402
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16501-1758
Practice Address - Country:US
Practice Address - Phone:814-464-0627
Practice Address - Fax:814-464-0629
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA12150409235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist