Individual
AMANDA BACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS SLP-CCC
Contact information
Practice address
105 DANIEL DR, DANVILLE, KY 40422-2527
(859) 239-6670
Mailing address
108 MOLLY CIR, NICHOLASVILLE, KY 40356-2675
(859) 552-3061
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
05036
KY
Other
Enumeration date
05/24/2007
Last updated
07/08/2007
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