Healthcare Provider Details

I. General information

NPI: 1710149034
Provider Name (Legal Business Name): AMBER ESPINOLA MS,CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2008
Last Update Date: 03/10/2020
Certification Date: 03/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1056 HUNTERS POINTE LN
BOWLING GREEN KY
42104-7208
US

IV. Provider business mailing address

1056 HUNTERS POINTE LN
BOWLING GREEN KY
42104-7208
US

V. Phone/Fax

Practice location:
  • Phone: 270-202-5998
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3238
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: