Healthcare Provider Details

I. General information

NPI: 1649906843
Provider Name (Legal Business Name): AMY MEARS M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMY PEARSON M.S.,CCC-SLP

II. Dates (important events)

Enumeration Date: 07/29/2022
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 W DALLAS ST
WOLFE CITY TX
75496-3446
US

IV. Provider business mailing address

201 AZALEA LN
HEADLAND AL
36345-1598
US

V. Phone/Fax

Practice location:
  • Phone: 903-496-2032
  • Fax:
Mailing address:
  • Phone: 432-238-4701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number112504
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: