Individual
MS. AMANDA SUZANNE POTTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
204 WEST HOLLOWAY AVE, BISMARCK, IL 61814
(217) 304-1595
Mailing address
204 WEST HOLLOWAY AVE, BISMARCK, IL 61814
(217) 304-1595
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
146.007731
IL
Other
Enumeration date
04/16/2014
Last updated
04/16/2014
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