Amanda Ball
Individual provider Active NPI Speech-Language Pathologist · Coeur D Alene, ID
NPI 1992153282 · NPPES record last updated May 27, 2020
Key facts
- NPI
- 1992153282
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- SLP-4295 (ID)
- Practice address
- 917 W Canfield Ave
Coeur D Alene, ID 83815-9764 - Phone
- (208) 762-3502
- Fax
- (888) 310-4824
- NPI assigned
- May 27, 2016
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SLP-4295 | ID | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Periwinkle Children'S Therapy | Past |
Accepting new patients | |
| Periwinkle Children'S Therapy | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SLP-4295 | ID | Yes |
Addresses
Primary practice location
917 W Canfield Ave
Coeur D Alene, ID 83815-9764
Mailing address
917 W Canfield Ave
Coeur D Alene, ID 83815-9764
Phone (208) 762-3502
Other practice location 1
528 E Spokane Falls Blvd
Suite 14
Spokane, WA 99202-5081
Phone (509) 328-1582
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992153282 | Medicaid | ID |
Other providers in Coeur D Alene, ID
- Carol Jean Baker
- Elaine Elizabeth Baker
- Megan Baker
- Shayla Baker
- Tracie Lynn Baker
- Philip Anders Ballance
- Franciosa Soreno Ballard
- Desiree Barclift
- Julianna Bardgett
- Lynda Barker
All providers in Coeur D Alene, ID · Speech-Language Pathologist in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 27, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.