Healthcare Provider Details

I. General information

NPI: 1396950366
Provider Name (Legal Business Name): AMY ELIZABETH ECCLESTON MS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2007
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 EMERALD SOUND BLVD
LITTLE ELM TX
75068-2230
US

IV. Provider business mailing address

920 EMERALD SOUND BLVD
LITTLE ELM TX
75068-2230
US

V. Phone/Fax

Practice location:
  • Phone: 469-855-0462
  • Fax:
Mailing address:
  • Phone: 469-855-0462
  • Fax: 940-365-0763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number19661
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: