Healthcare Provider Details

I. General information

NPI: 1578790606
Provider Name (Legal Business Name): AMY PORTER ECKLUND MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2009
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 218
LEANDER TX
78646-0218
US

IV. Provider business mailing address

PO BOX 218
LEANDER TX
78646-0218
US

V. Phone/Fax

Practice location:
  • Phone: 512-570-0000
  • Fax: 512-570-0054
Mailing address:
  • Phone: 512-570-0000
  • Fax: 512-570-0054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number105036
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: