Active NPI
Amanda Evanko, CCC-SLP
- Speech-Language Pathologist
- Stratford, CT
National Provider Identifier
1588067599
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 004489
- Practice address
- 695 Chapel St
Stratford, CT 06614-1672 - Phone
- (203) 993-9913
- NPI assigned
- Oct 3, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 004489 | CT | Primary |
Addresses
Primary practice location
695 Chapel St
Stratford, CT 06614-1672
Mailing address
695 Chapel St
Stratford, CT 06614-1672
Phone (203) 993-9913
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 004489 | CT | MD | Clinical Social Worker |
| 4489 | CT | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1412294400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1412294400000",
"number": "1588067599",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "695 CHAPEL ST",
"city": "STRATFORD",
"state": "CT",
"postal_code": "066141672",
"telephone_number": "203-993-9913"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "695 CHAPEL ST",
"city": "STRATFORD",
"state": "CT",
"postal_code": "066141672",
"telephone_number": "203-993-9913"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EVANKO",
"first_name": "AMANDA",
"name_prefix": "Ms.",
"credential": "CCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-10-03",
"last_updated": "2014-10-03",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "CT",
"license": "004489",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stratford, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.