Provider Demographics
NPI:1538437801
Name:SMALL, AMANDA BOYLES (MA,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:BOYLES
Last Name:SMALL
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:NICOLE
Other - Last Name:BOYLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA,CCC-SLP
Mailing Address - Street 1:6140 WOODSIDE EXECUTIVE COURT
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-3822
Mailing Address - Country:US
Mailing Address - Phone:803-642-0700
Mailing Address - Fax:803-642-0588
Practice Address - Street 1:6140 WOODSIDE EXECUTIVE COURT
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-3822
Practice Address - Country:US
Practice Address - Phone:803-642-0700
Practice Address - Fax:803-642-0588
Is Sole Proprietor?:No
Enumeration Date:2011-12-01
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4949235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist