Provider Demographics
NPI:1699341503
Name:DEFURIA, AMANDA ISABELLE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:ISABELLE
Last Name:DEFURIA
Suffix:
Gender:
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 CHRISTINE DR
Mailing Address - Street 2:
Mailing Address - City:ATKINSON
Mailing Address - State:NH
Mailing Address - Zip Code:03811-2303
Mailing Address - Country:US
Mailing Address - Phone:978-478-7094
Mailing Address - Fax:
Practice Address - Street 1:319 E DUNSTABLE RD
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062-4207
Practice Address - Country:US
Practice Address - Phone:603-888-7878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-01
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH14408719235Z00000X
390200000X, 235Z00000X
NH2224235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program