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General NPI Number Information
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NPI Number | 1649906843
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Entity Type | Individual
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Provider Name | AMY MEARS M.S., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 07/29/2022
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Last Update Date | 07/29/2022
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Provider Practice Location Address
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Address Line | 505 W DALLAS ST
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City | WOLFE CITY
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State | TX
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Zip | 75496-3446
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Country | US
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Telephone | 903-496-2032
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Fax |
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Provider Business Mailing Address
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Address Line | 201 AZALEA LN
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City | HEADLAND
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State | AL
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Zip | 36345-1598
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Country | US
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Telephone | 432-238-4701
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 112504
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License Number State | TX
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