Provider Demographics
NPI:1093940488
Name:VARGAS, AMIE SUE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:AMIE
Middle Name:SUE
Last Name:VARGAS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MS
Other - First Name:AMIE
Other - Middle Name:SUE
Other - Last Name:MCGRAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:5069 W DIGORY DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84009-5878
Mailing Address - Country:US
Mailing Address - Phone:702-343-1673
Mailing Address - Fax:
Practice Address - Street 1:5069 W DIGORY DR
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84009-5878
Practice Address - Country:US
Practice Address - Phone:702-343-1673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-28
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8723481-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty