Individual
MRS. AMANDA MIZELLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S.CCC-SLP
Contact information
Practice address
35 REFERENDUM DR NE, BOLIVIA, NC 28422-7578
(910) 406-5100
(866) 293-0649
Mailing address
2003 E OAK ISLAND DR STE 4, OAK ISLAND, NC 28465-6326
(919) 815-5046
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2980
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
018CV
BLUE CROSS BLUE SHIELD
NC
05
—
7212036
—
NC
05
—
7412516
—
NC
Enumeration date
02/28/2007
Last updated
03/31/2026
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