Provider Demographics
NPI:1538825294
Name:GIDDENS, AMANDA NICHOLE (SPEECH PATHOLOGIST)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:NICHOLE
Last Name:GIDDENS
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:736 BROOKHURST DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-2256
Mailing Address - Country:US
Mailing Address - Phone:468-835-8117
Mailing Address - Fax:
Practice Address - Street 1:8050 MEADOW RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3406
Practice Address - Country:US
Practice Address - Phone:469-232-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101983235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist