Provider Demographics
NPI:1164145876
Name:TAYLOR-RESTINE, AMY SUZAN (SLP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:SUZAN
Last Name:TAYLOR-RESTINE
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 1:8100 PINERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119-4929
Mailing Address - Country:US
Mailing Address - Phone:806-677-2479
Mailing Address - Fax:806-677-2499
Practice Address - Street 1:8100 PINERIDGE DR
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-4929
Practice Address - Country:US
Practice Address - Phone:806-677-2479
Practice Address - Fax:806-677-2499
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104411235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX104411OtherSPEECH THERAPY LICENSE