Provider Demographics
NPI:1588277826
Name:HACKETT, AMANDA TRECO (MA CCC-SLP TSSLD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:TRECO
Last Name:HACKETT
Suffix:
Gender:F
Credentials:MA CCC-SLP TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 LAFAYETTE PL
Mailing Address - Street 2:
Mailing Address - City:SEA CLIFF
Mailing Address - State:NY
Mailing Address - Zip Code:11579-1935
Mailing Address - Country:US
Mailing Address - Phone:516-286-1286
Mailing Address - Fax:
Practice Address - Street 1:6 LAFAYETTE PL
Practice Address - Street 2:
Practice Address - City:SEA CLIFF
Practice Address - State:NY
Practice Address - Zip Code:11579-1935
Practice Address - Country:US
Practice Address - Phone:516-286-1286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP4253235Z00000X
NY029278235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist