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NPI Code Detail

MEDICARE: AMY RENAE HERBERT CCC, SLP

MEDICARE: AMY RENAE HERBERT CCC, SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language PathologistAL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
114109551OTHERALASHA CERTIFICATION

General Provider Information

NPI Number : 1053705129
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY RENAE HERBERT CCC, SLP
Provider Business Mailing Address
First Line : 6017 WASHINGTON AVE
Second Line :
City : OCEAN SPRINGS
State : MS
Zip : 39564-2648
Country : US
Telephone Number : 228-697-2269
Fax Number :
Provider Business Practice Location Address
First Line : 6017 WASHINGTON AVE
Second Line :
City : OCEAN SPRINGS
State : MS
Zip : 39564-2648
Country : US
Telephone Number : 228-697-2269
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2015
Last Update Date : 08/04/2018

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