Provider Demographics
NPI:1073957569
Name:KING, AMY (MSCCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 SARDIS RD N
Mailing Address - Street 2:SUITE 112
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-7711
Mailing Address - Country:US
Mailing Address - Phone:704-845-6134
Mailing Address - Fax:704-845-8024
Practice Address - Street 1:2101 SARDIS RD N
Practice Address - Street 2:SUITE 112
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227-7711
Practice Address - Country:US
Practice Address - Phone:704-845-6134
Practice Address - Fax:704-845-8024
Is Sole Proprietor?:No
Enumeration Date:2013-04-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10008177235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7200296Medicaid