Provider Demographics
NPI:1164792131
Name:IVESTER, AMY ELIZABETH FIELD (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:ELIZABETH FIELD
Last Name:IVESTER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 RIDGE GATE DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27023-8690
Mailing Address - Country:US
Mailing Address - Phone:336-408-2404
Mailing Address - Fax:
Practice Address - Street 1:8800 BUCKEY CT
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27023-7745
Practice Address - Country:US
Practice Address - Phone:336-946-2493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7042235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist