Provider Demographics
NPI:1902525074
Name:CUMBIE, AMANDA G (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:G
Last Name:CUMBIE
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 WHITLEY RD
Mailing Address - Street 2:
Mailing Address - City:WATAUGA
Mailing Address - State:TX
Mailing Address - Zip Code:76148-1211
Mailing Address - Country:US
Mailing Address - Phone:817-744-5800
Mailing Address - Fax:
Practice Address - Street 1:7600 WHITLEY RD
Practice Address - Street 2:
Practice Address - City:WATAUGA
Practice Address - State:TX
Practice Address - Zip Code:76148-1211
Practice Address - Country:US
Practice Address - Phone:817-744-5800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100395235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist