Provider Demographics
NPI:1003058223
Name:SHORES, AMY R (SLP)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:R
Last Name:SHORES
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:CARROLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10 SOUTH EUCLID AVE.
Mailing Address - Street 2:SUITE G
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-3808
Mailing Address - Country:US
Mailing Address - Phone:314-367-7711
Mailing Address - Fax:314-367-0177
Practice Address - Street 1:10 SOUTH EUCLID AVE.
Practice Address - Street 2:SUITE G
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-3808
Practice Address - Country:US
Practice Address - Phone:314-367-7711
Practice Address - Fax:314-367-0177
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006004092235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist