Provider Demographics
NPI:1962955047
Name:CAUDILL, AMANDA MICHELLE
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:MICHELLE
Last Name:CAUDILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 BUSINESS PARK DR.
Mailing Address - Street 2:SUITE 11
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37090
Mailing Address - Country:US
Mailing Address - Phone:615-443-4445
Mailing Address - Fax:
Practice Address - Street 1:163 BUSINESS PARK DR STE 11
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37090-1248
Practice Address - Country:US
Practice Address - Phone:615-443-4445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4953235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist