Individual
AMANDA S DIETZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS-CCC, SLP
Contact information
Practice address
10 BELLMORE PL., PALM COAST, FL 32137
(386) 627-0632
Mailing address
10 BELLMORE PL., PALM COAST, FL 32137
(386) 627-0632
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SA8518
FL
Other
Enumeration date
11/03/2008
Last updated
04/26/2012
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