Basic Information
| Provider Information | |||||||||
| NPI: | 1295041077 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LYMANGOOD | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.A. CCC-SLP | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | GRANTHAM | ||||||||
| OtherFirstName: | AMANDA | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 7900 W 28TH ST | ||||||||
| Address2: | |||||||||
| City: | ST LOUIS PARK | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554263011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9529208380 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7900 W 28TH ST | ||||||||
| Address2: | |||||||||
| City: | ST LOUIS PARK | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554263011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9529203859 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2010 | ||||||||
| LastUpdateDate: | 11/15/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 8835 | MN | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 3394 | WI | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.