Individual
AMANDA FORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
9400 MAYFIELD CT, MANASSAS, VA 20110-5794
(571) 377-6721
Mailing address
10978 CATTAIL CT, MANASSAS, VA 20109-7255
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2202008708
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2202008708
COMMONWEALTH OF VA, DEPARTMENT OF HEALTH PROFESSIONS
VA
Enumeration date
01/29/2018
Last updated
01/29/2018
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