Provider Demographics
NPI:1053548834
Name:HUTTER, AMANDA HATFIELD (CCC-SLP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:HATFIELD
Last Name:HUTTER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:ELIZABETH
Other - Last Name:HATFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:210 4TH ST
Mailing Address - Street 2:APT A
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-1627
Mailing Address - Country:US
Mailing Address - Phone:706-721-2482
Mailing Address - Fax:
Practice Address - Street 1:1120 15TH ST STE BI1056
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-1627
Practice Address - Country:US
Practice Address - Phone:706-721-3813
Practice Address - Fax:706-721-1459
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007360235Z00000X
GAPCET001437235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA312717695BMedicaid