Healthcare Provider Details

I. General information

NPI: 1568741692
Provider Name (Legal Business Name): AMBER LYNN SCOGGIN M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

781 SCOGGIN RD
DECATUR MS
39327-9342
US

IV. Provider business mailing address

12732 HICKORY LITTLE ROCK RD
DECATUR MS
39327-9281
US

V. Phone/Fax

Practice location:
  • Phone: 601-480-8428
  • Fax:
Mailing address:
  • Phone: 601-480-8428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: