Healthcare Provider Details

I. General information

NPI: 1659445195
Provider Name (Legal Business Name): AMY MICHELLE FEILD CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 I 55 NORTH SUITE 291, HIGHLAND VILLAGE
JACKSON MS
39211
US

IV. Provider business mailing address

112 THORNBERRY CV
MADISON MS
39110-7050
US

V. Phone/Fax

Practice location:
  • Phone: 601-362-0859
  • Fax:
Mailing address:
  • Phone: 601-898-2603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberS2284
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: