Provider Demographics
NPI:1093799280
Name:AMBROSE, MAEVE SUSAN (SLP)
Entity Type:Individual
Prefix:MRS
First Name:MAEVE
Middle Name:SUSAN
Last Name:AMBROSE
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 1:1255 HOCKBERRY RD
Mailing Address - Street 2:
Mailing Address - City:REN
Mailing Address - State:NV
Mailing Address - Zip Code:89510
Mailing Address - Country:US
Mailing Address - Phone:775-424-1255
Mailing Address - Fax:775-475-0863
Practice Address - Street 1:1255 HOCKBERRY RD
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89510
Practice Address - Country:US
Practice Address - Phone:775-424-1255
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV69235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV69OtherBOARD OF MEDICAL EXAMINER
NV3416014Medicaid