Basic Information
| Provider Information | |||||||||
| NPI: | 1609057249 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ABEL | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | S.L.P | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LEPAGE | ||||||||
| OtherFirstName: | AMANDA | ||||||||
| OtherMiddleName: | J | ||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 24988 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981240988 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034436156 | ||||||||
| FaxNumber: | 5036399699 | ||||||||
| Practice Location | |||||||||
| Address1: | 1315 NW 4TH ST | ||||||||
| Address2: | SUITE B | ||||||||
| City: | REDMOND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977561328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5419237494 | ||||||||
| FaxNumber: | 5415049153 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/26/2007 | ||||||||
| LastUpdateDate: | 11/26/2007 | ||||||||
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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 | 12733 | OR | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.