Provider Demographics
NPI:1073197075
Name:AMPLIFY SPEECH & LANGUAGE SERVICES
Entity Type:Organization
Organization Name:AMPLIFY SPEECH & LANGUAGE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:WIMER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:404-667-9032
Mailing Address - Street 1:171 MOULTRIE ST MSC BOX 146
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29409-0001
Mailing Address - Country:US
Mailing Address - Phone:404-667-9032
Mailing Address - Fax:
Practice Address - Street 1:109 REGISTER RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29409-0001
Practice Address - Country:US
Practice Address - Phone:404-667-9032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty