Amanda Van Staden, M.S., CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SLP009103 Issued in GA

Practice address

1230 Johnson Ferry PL Ste G10
Marietta, GA 30068-2045

Phone

(770) 321-6705

NPI assigned

Feb 8, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1454889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599523200000",
    "number": "1093173825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1230 JOHNSON FERRY PL STE G10",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300682045",
            "telephone_number": "770-321-6705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1230 JOHNSON FERRY PL STE G10",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300682045",
            "telephone_number": "770-321-6705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN STADEN",
        "first_name": "AMANDA",
        "credential": "M.S., CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-02-08",
        "last_updated": "2020-09-08",
        "certification_date": "2020-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "SLP009103",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ASHA",
            "identifier": "14113603",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.buildingblockspediatric.com/",
            "affiliation": "N",
            "address_1": "1230 Johnson Ferry Pl Ste G10",
            "city": "Marietta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300682045",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Andrew N Van Devender, MSW
• Felesia Ann Van Lee, MSW
• Patrick Van Middelem, MS, LPC
• Erika Sandra Van Putten, MD
• Stefan R Van Sant
• Maria Danielle Van Tiflin, D.P.T
• Raymond M Van Tiflin III, DPT
• Robert Jarrod Vanatta, ATC
• Vance Chiropractic PC
• August Vance, DC

• Speech-Language Pathologist in Marietta, GA
• Providers in Marietta, GA by specialty
• Speech-Language Pathologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.