Healthcare Provider Details

I. General information

NPI: 1306761978
Provider Name (Legal Business Name): AMY LYNN THOMPSON ED.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 CEDAR SHOALS DR
ATHENS GA
30605-3541
US

IV. Provider business mailing address

143 CHINQUAPIN WAY
ATHENS GA
30605-3315
US

V. Phone/Fax

Practice location:
  • Phone: 706-546-5375
  • Fax:
Mailing address:
  • Phone: 706-546-5375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP012699
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: