MEDICARE: AMELIA HAYMES

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
1	235Z00000X	Speech-Language Pathologist	2003010145	MO

General Provider Information

NPI Number	:	1639954498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMELIA HAYMES

Provider Business Mailing Address
First Line	:	236 CLEARSPRING RD
Second Line	:
City	:	SPARTA
State	:	MO
Zip	:	65753-9457
Country	:	US
Telephone Number	:	417-773-2129
Fax Number	:

Provider Business Practice Location Address
First Line	:	1146 E LAKEWOOD ST
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65810-2614
Country	:	US
Telephone Number	:	417-261-5952
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2023
Last Update Date	:	08/30/2023

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Directions to “ AMELIA HAYMES ” Practice Location

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