Provider Demographics
NPI:1629106588
Name:KETT, AMANDA O'HANLON (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:O'HANLON
Last Name:KETT
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 1:7670 E. BROADWAY BLVD.
Mailing Address - Street 2:STE 108
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-3440
Mailing Address - Country:US
Mailing Address - Phone:520-437-2210
Mailing Address - Fax:520-367-6054
Practice Address - Street 1:7670 E. BROADWAY BLVD.
Practice Address - Street 2:STE 108
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-3440
Practice Address - Country:US
Practice Address - Phone:520-437-2210
Practice Address - Fax:520-367-6054
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTSLP5328235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist