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NPI Code Detail

MEDICARE: AMY RENEE BLACK M.A, CCC-SLP

MEDICARE:   AMY RENEE BLACK  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
1235Z00000XSpeech-Language Pathologist1281TN

General Provider Information

NPI Number : 1417967878
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY RENEE BLACK M.A, CCC-SLP
Provider Business Mailing Address
First Line : 310 CORPORATE DR STE 101
Second Line :
City : KNOXVILLE
State : TN
Zip : 37923-4690
Country : US
Telephone Number : 865-693-5622
Fax Number :
Provider Business Practice Location Address
First Line : 310 CORPORATE DR STE 101
Second Line :
City : KNOXVILLE
State : TN
Zip : 37923-4638
Country : US
Telephone Number : 865-693-5622
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2006
Last Update Date : 06/23/2025

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Directions to “ AMY RENEE BLACK M.A, CCC-SLP” Practice Location

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