Provider Demographics
NPI:1124750211
Name:MARTIN, AMANDA JUNE (CF-SLP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:JUNE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1290 E SPRINGFIELD PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-1340
Mailing Address - Country:US
Mailing Address - Phone:623-241-3755
Mailing Address - Fax:
Practice Address - Street 1:4132 E ADOBE ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-5110
Practice Address - Country:US
Practice Address - Phone:480-472-7365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-28
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTSLP16324235Z00000X
AZSLPA138912355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant