Provider Demographics
NPI:1063824001
Name:VALENTINE, AMBER DAWN (MS, CCC-SLP, BCS-S,)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:DAWN
Last Name:VALENTINE
Suffix:
Gender:F
Credentials:MS, CCC-SLP, BCS-S,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1761 FIDDLERS RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-7241
Mailing Address - Country:US
Mailing Address - Phone:859-358-6864
Mailing Address - Fax:
Practice Address - Street 1:4500 SAN PABLO RD S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-1865
Practice Address - Country:US
Practice Address - Phone:859-358-6864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-26
Last Update Date:2015-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 12928235Z00000X
KYKY 3283235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist