Provider Demographics
NPI:1992913305
Name:CARLSON, AMANDA KAY (MA, CCC)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:KAY
Last Name:CARLSON
Suffix:
Gender:F
Credentials:MA, CCC
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:KAY
Other - Last Name:ERCHENBRECHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC
Mailing Address - Street 1:839 PEARL RD
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-2559
Mailing Address - Country:US
Mailing Address - Phone:330-225-4182
Mailing Address - Fax:330-225-4879
Practice Address - Street 1:839 PEARL RD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-2559
Practice Address - Country:US
Practice Address - Phone:330-225-4182
Practice Address - Fax:330-225-4879
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15571235Z00000X
OHSP-7716235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist