Individual
AMANDA POLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
6360 6TH AVE N, ST PETERSBURG, FL 33710-6906
(727) 415-2962
Mailing address
6360 6TH AVE N, ST PETERSBURG, FL 33710-6906
(727) 415-2962
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SA12622
FL
235Z00000X
Speech-Language Pathologist
SZ5969
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006609700
—
FL
Enumeration date
09/18/2012
Last updated
03/27/2018
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