Provider Demographics
NPI:1720576606
Name:PIRTLE, AMANDA BOWEN
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:BOWEN
Last Name:PIRTLE
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 1:914B WESTBROOK DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-3352
Mailing Address - Country:US
Mailing Address - Phone:198-024-1425
Mailing Address - Fax:
Practice Address - Street 1:914B WESTBROOK DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-3352
Practice Address - Country:US
Practice Address - Phone:980-224-3894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-26
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12941235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist