Individual
AMANDA BRENTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
118 STILLMEADOW DR, LIZTON, IN 46149-9243
(317) 856-5201
Mailing address
118 STILLMEADOW DR, LIZTON, IN 46149-9243
(317) 856-5201
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
22004549A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22004549A
STATE LICENSE
IN
Enumeration date
12/04/2008
Last updated
12/04/2008
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