Provider Demographics
NPI:1083842561
Name:HUSTON, AMY ELIZABETH (SLP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:ELIZABETH
Last Name:HUSTON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 WALLINGWOOD DR BLDG 2
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6900
Mailing Address - Country:US
Mailing Address - Phone:512-327-6179
Mailing Address - Fax:512-327-1545
Practice Address - Street 1:1121 E 7TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-3220
Practice Address - Country:US
Practice Address - Phone:512-334-4411
Practice Address - Fax:512-334-4465
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2017-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102852235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX102852Medicaid