Healthcare Provider Details

I. General information

NPI: 1184748402
Provider Name (Legal Business Name): AMY PERRY TIPTON M.A.CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 13TH ST
HUNTINGTON WV
25701-1653
US

IV. Provider business mailing address

15D QUAIL DR
ONA WV
25545-9521
US

V. Phone/Fax

Practice location:
  • Phone: 304-525-7622
  • Fax:
Mailing address:
  • Phone: 304-733-1997
  • Fax: 304-733-2593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number0639
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: