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General NPI Number Information
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NPI Number | 1730150186
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Entity Type | Individual
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Provider Name | AMIE MICHELLE TEAGUE MA/CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 02/01/2006
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Last Update Date | 07/18/2023
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Provider Practice Location Address
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Address Line | 159 EXECUTIVE DR STE A
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City | DANVILLE
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State | VA
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Zip | 24541-4160
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Country | US
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Telephone | 434-228-1812
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 10864
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City | DANVILLE
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State | VA
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Zip | 24543-5015
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Country | US
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Telephone | 434-228-1812
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Fax | 866-468-5040
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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 | 6794
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 2202003828
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License Number State | VA
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