Individual
AMANDA VAN STADEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
1230 JOHNSON FERRY PL STE G10, MARIETTA, GA 30068-2045
(770) 321-6705
Mailing address
1230 JOHNSON FERRY PL STE G10, MARIETTA, GA 30068-2045
(770) 321-6705
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP009103
GA
235Z00000X
Speech-Language Pathologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14113603
ASHA
—
Enumeration date
02/08/2016
Last updated
09/08/2020
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