Amanda Carol Mavrakos, M.S., CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

4465 Issued in AL

Practice address

400 Vestavia Pkwy Ste 135
Vestavia, AL 35216-3784

Phone

(205) 582-7717

Fax

(205) 855-3017

NPI assigned

May 12, 2021

Last updated

Dec 28, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Salt & Light Speech-Language Resources LLC

  • Speech-Language Pathologist
  • Vestavia, AL
  • NPI 1952970063
  NPD Authorized official

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

{
    "created_epoch": "1620777600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703721600000",
    "number": "1730763962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 VESTAVIA PKWY STE 135",
            "city": "VESTAVIA",
            "state": "AL",
            "postal_code": "352163784",
            "telephone_number": "205-582-7717",
            "fax_number": "205-855-3017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 VESTAVIA PKWY STE 135",
            "city": "VESTAVIA",
            "state": "AL",
            "postal_code": "352163784",
            "telephone_number": "205-582-7717",
            "fax_number": "205-855-3017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAVRAKOS",
        "first_name": "AMANDA",
        "middle_name": "CAROL",
        "credential": "M.S., CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-05-12",
        "last_updated": "2023-12-28",
        "certification_date": "2023-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "AL",
            "license": "4465",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.saltandlight-slp.com",
            "affiliation": "N",
            "address_1": "2035 Edgewood Dr",
            "city": "Moody",
            "state": "AL",
            "country_code": "US",
            "postal_code": "350043250",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Hollie Mason
• Kelley Massengale, LCSW-BACS
• Kadra Mathews
• Olivia Mathis
• Toby Thomas Mathis
• Elizabeth Pate Mayer
• Morgan Mayfield
• James Bernard McCabe Jr., RPH
• Rosa McCall
• Destiny McCarter

• Speech-Language Pathologist in Vestavia, AL
• Providers in Vestavia, AL by specialty
• Speech-Language Pathologist in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2023; 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.