Healthcare Provider Details

I. General information

NPI: 1003045550
Provider Name (Legal Business Name): AMBER MCCOLLISTER MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2009
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1247 RUCKER BLVD STE 1
ENTERPRISE AL
36330-3630
US

IV. Provider business mailing address

127 PATRICIA LN
DALEVILLE AL
36322-5309
US

V. Phone/Fax

Practice location:
  • Phone: 334-316-0191
  • Fax:
Mailing address:
  • Phone: 334-447-0456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4846
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: