Basic Information
| Provider Information | |||||||||
| NPI: | 1902575459 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | KIDD | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | MS, CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5000 CULBREATH KEY WAY APT 5501 | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336116012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8134687881 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2111 W SWANN AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336062478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8132511618 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2021 | ||||||||
| LastUpdateDate: | 10/24/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SZ10319 | FL | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | SA20671 | FL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.