Provider Demographics
NPI:1982152252
Name:MCKALLIP, AMANDA K (AUD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:K
Last Name:MCKALLIP
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:K
Other - Last Name:CZECH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:64 ELIZABETH BLACKWELL ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-3403
Mailing Address - Country:US
Mailing Address - Phone:315-789-3595
Mailing Address - Fax:315-789-9051
Practice Address - Street 1:64 ELIZABETH BLACKWELL ST
Practice Address - Street 2:SUITE C
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-3403
Practice Address - Country:US
Practice Address - Phone:315-789-3595
Practice Address - Fax:315-789-9051
Is Sole Proprietor?:No
Enumeration Date:2016-09-15
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002676231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist