Basic Information
Provider Information
NPI: 1033559190
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HERRMANN
FirstName: AMANDA
MiddleName: SARAH
NamePrefix:  
NameSuffix:  
Credential: M.S. SLP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 25615 N RANCH GATE RD
Address2:  
City: SCOTTSDALE
State: AZ
PostalCode: 852552141
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 25615 N RANCH GATE RD
Address2:  
City: SCOTTSDALE
State: AZ
PostalCode: 852552141
CountryCode: US
TelephoneNumber: 4805027726
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/02/2013
LastUpdateDate: 07/02/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
235Z00000XSLP8428AZY Speech, Language and Hearing Service ProvidersSpeech-Language Pathologist 

ID Information
IDTypeStateIssuerDescription
11247701AZARIZONA DEPARTMENT OF HEALTH SERVICESOTHER


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