Provider Demographics
NPI:1528894201
Name:SMITH, AMANDA K
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:K
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3286 S 225TH RD
Mailing Address - Street 2:
Mailing Address - City:GOODSON
Mailing Address - State:MO
Mailing Address - Zip Code:65663-7118
Mailing Address - Country:US
Mailing Address - Phone:417-224-1473
Mailing Address - Fax:
Practice Address - Street 1:1400 E FOREST ST
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-1214
Practice Address - Country:US
Practice Address - Phone:417-328-5615
Practice Address - Fax:417-328-5614
Is Sole Proprietor?:No
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20210393792355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant