MEDICARE: AMY MICHELLE VALENCIA M.S. 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
1	235Z00000X	Speech-Language Pathologist	102118	TX

General Provider Information

NPI Number	:	1730406497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY MICHELLE VALENCIA M.S. CCC/SLP

Provider Business Mailing Address
First Line	:	4845 BRIDLE PATH WAY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-7911
Country	:	US
Telephone Number	:	817-229-1332
Fax Number	:

Provider Business Practice Location Address
First Line	:	4845 BRIDLE PATH WAY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-7911
Country	:	US
Telephone Number	:	817-229-1332
Fax Number	:

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

Provider Enumeration Date	:	04/21/2010
Last Update Date	:	04/21/2010

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