Individual
MRS. AMANDA NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MCD, CFY-SLP
Contact information
Practice address
1606 PINE GROVE LN, HARRISBURG, AR 72432-9304
(870) 476-3439
Mailing address
2640 GLENN PL APT 38, JONESBORO, AR 72404-7847
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP#P8904
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
208514721
—
AR
Enumeration date
04/20/2015
Last updated
09/24/2015
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