Provider Demographics
NPI:1679302814
Name:HOUSLANDER, AMANDA JOEL (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:JOEL
Last Name:HOUSLANDER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 FAIRWAY CT
Mailing Address - Street 2:
Mailing Address - City:BUNNELL
Mailing Address - State:FL
Mailing Address - Zip Code:32110-3410
Mailing Address - Country:US
Mailing Address - Phone:847-826-6801
Mailing Address - Fax:
Practice Address - Street 1:55 PLAZA DR STE 6
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-8550
Practice Address - Country:US
Practice Address - Phone:386-346-0523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-27
Last Update Date:2024-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ11405235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist