Provider Demographics
NPI:1982950366
Name:VALVEZAN, AMANDA E
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:E
Last Name:VALVEZAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:E
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 SKILES BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-7321
Mailing Address - Country:US
Mailing Address - Phone:800-578-7906
Mailing Address - Fax:800-878-5497
Practice Address - Street 1:200 SKILES BLVD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-7321
Practice Address - Country:US
Practice Address - Phone:800-578-7906
Practice Address - Fax:800-878-5497
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-03
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL010660235Z00000X
MASP-9015-SL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist