Provider Demographics
NPI:1184939449
Name:DUBOSE, AMANDA L (SLP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:L
Last Name:DUBOSE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 HILL COUNTRY DR
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-6085
Mailing Address - Country:US
Mailing Address - Phone:302-943-9569
Mailing Address - Fax:
Practice Address - Street 1:135 PLAZA DR
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-2230
Practice Address - Country:US
Practice Address - Phone:830-460-9364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-11
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE04-0000282163WS0200X
DE01-0001165235Z00000X
TX111074235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No163WS0200XNursing Service ProvidersRegistered NurseSchool