Individual
MRS. AMANDA MCGUKIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
515 TIMBER LAKE DR, SOUTHLAKE, TX 76092-7206
(949) 468-9348
Mailing address
515 TIMBER LAKE DR, SOUTHLAKE, TX 76092-7206
(949) 468-9348
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
107234
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
287168301
—
TX
01
—
81S586
BCBS
TX
Enumeration date
01/06/2012
Last updated
02/04/2014
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