Provider Demographics
NPI:1366720559
Name:CARTER, AMANDA MONIQUE (MS CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:MONIQUE
Last Name:CARTER
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12922 AMBROSE DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-2360
Mailing Address - Country:US
Mailing Address - Phone:214-793-8545
Mailing Address - Fax:469-579-4381
Practice Address - Street 1:12922 AMBROSE DR
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-2360
Practice Address - Country:US
Practice Address - Phone:214-793-8545
Practice Address - Fax:469-579-4381
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-22
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105288235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist