MEDICARE: MRS. AMY PINCKNEY M.A. 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
1	235Z00000X	Speech-Language Pathologist	3228	SC

Other Identifiers

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

General Provider Information

NPI Number	:	1225230188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMY PINCKNEY M.A. CCC-SLP

Provider Business Mailing Address
First Line	:	1004 10TH ST
Second Line	:
City	:	PORT ROYAL
State	:	SC
Zip	:	29935-2310
Country	:	US
Telephone Number	:	843-310-9690
Fax Number	:	800-317-9690

Provider Business Practice Location Address
First Line	:	95 ROSE ISLAND RD
Second Line	:
City	:	SAINT HELENA ISLAND
State	:	SC
Zip	:	29920-3915
Country	:	US
Telephone Number	:	843-838-9026
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2007
Last Update Date	:	12/07/2015

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