Provider Demographics
NPI:1942482344
Name:AUSTIN-ELLIS, AMANDA LEIGH (SLP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEIGH
Last Name:AUSTIN-ELLIS
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 1:14410 MAGIC RIVER DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-2261
Mailing Address - Country:US
Mailing Address - Phone:217-714-4678
Mailing Address - Fax:
Practice Address - Street 1:11711 TELGE RD
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-3795
Practice Address - Country:US
Practice Address - Phone:217-714-4678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-28
Last Update Date:2025-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104390235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist