Basic Information
| Provider Information | |||||||||
| NPI: | 1043486160 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GILBERT | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | LYNN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 649 ALEXANDER CROSSINGS | ||||||||
| Address2: | |||||||||
| City: | PLANT CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33563 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8137524000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1335 ARIANA ST | ||||||||
| Address2: | |||||||||
| City: | LAKELAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338031879 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8634130802 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2008 | ||||||||
| LastUpdateDate: | 05/06/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SA9115 | FL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.