MEDICARE: AMY STEVENSON M.A., CCC-A

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	231H00000X	Audiologist	0000001159	TN

General Provider Information

NPI Number	:	1447424478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY STEVENSON M.A., CCC-A

Provider Business Mailing Address
First Line	:	1724 HAMILL RD
Second Line	:	OASIS PARK BUILDING I, SUITE 102
City	:	HIXSON
State	:	TN
Zip	:	37343-4905
Country	:	US
Telephone Number	:	423-209-9111
Fax Number	:	423-209-9106

Provider Business Practice Location Address
First Line	:	1724 HAMILL RD
Second Line	:	OASIS PARK BUILDING I, SUITE 102
City	:	HIXSON
State	:	TN
Zip	:	37343-4905
Country	:	US
Telephone Number	:	423-209-9111
Fax Number	:	423-209-9106

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

Provider Enumeration Date	:	04/22/2008
Last Update Date	:	04/22/2008

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