Provider Demographics
NPI:1760786438
Name:CORR, AMANDA (LMT, SLP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:CORR
Suffix:
Gender:F
Credentials:LMT, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6832 NE CLAREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-4042
Mailing Address - Country:US
Mailing Address - Phone:503-680-0900
Mailing Address - Fax:
Practice Address - Street 1:6165 NE ALTON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-3219
Practice Address - Country:US
Practice Address - Phone:503-680-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-10
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14579225700000X
OR18311235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR18311OtherOREGON BOARD OF SPEECH LANGUAGE PATHOLOGY