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NPI Code Detail

MEDICARE: MRS. AMY MICHELLE DOUGLASS MS CCC-SLP

MEDICARE: MRS. AMY MICHELLE DOUGLASS MS CCC-SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language PathologistSA10624FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1003154329
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. AMY MICHELLE DOUGLASS MS CCC-SLP
Provider Business Mailing Address
First Line : 2206 NE 38TH TER
Second Line :
City : OCALA
State : FL
Zip : 34470-8176
Country : US
Telephone Number : 352-895-5803
Fax Number :
Provider Business Practice Location Address
First Line : 521 NE 25TH AVE
Second Line :
City : OCALA
State : FL
Zip : 34470-7034
Country : US
Telephone Number : 352-401-7916
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/21/2013
Last Update Date : 09/08/2014

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Directions to “ MRS. AMY MICHELLE DOUGLASS MS CCC-SLP” Practice Location

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