Provider Demographics
NPI:1013569250
Name:MEDLIN, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:MEDLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 W LOOP 340
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-6840
Mailing Address - Country:US
Mailing Address - Phone:254-399-8255
Mailing Address - Fax:
Practice Address - Street 1:601 W LOOP 340
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-6840
Practice Address - Country:US
Practice Address - Phone:254-399-8255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist