Provider Demographics
NPI:1003084609
Name:POWELL, AMBER (MA SLP-CFY)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:MA SLP-CFY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 AUTUMN DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-1725
Mailing Address - Country:US
Mailing Address - Phone:931-980-9877
Mailing Address - Fax:
Practice Address - Street 1:1621 AUTUMN DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-1725
Practice Address - Country:US
Practice Address - Phone:931-980-9877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist