Healthcare Provider Details

I. General information

NPI: 1548606700
Provider Name (Legal Business Name): AMBER BLOUGH M. S., CCC-SLP/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2013
Last Update Date: 05/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3053 NEW GERMANY RD
EBENSBURG PA
15931-3516
US

IV. Provider business mailing address

3053 NEW GERMANY RD
EBENSBURG PA
15931-3516
US

V. Phone/Fax

Practice location:
  • Phone: 814-472-1100
  • Fax: 814-472-1105
Mailing address:
  • Phone: 814-472-1100
  • Fax: 814-472-1105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSL011061
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: