Provider Demographics
NPI:1730763962
Name:MAVRAKOS, AMANDA CAROL (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:CAROL
Last Name:MAVRAKOS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:400 VESTAVIA PKWY STE 135
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35216-3784
Mailing Address - Country:US
Mailing Address - Phone:205-582-7717
Mailing Address - Fax:205-855-3017
Practice Address - Street 1:400 VESTAVIA PKWY STE 135
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35216-3784
Practice Address - Country:US
Practice Address - Phone:205-582-7717
Practice Address - Fax:205-855-3017
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-12
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL4465235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist