Provider Demographics
NPI:1194230359
Name:PARNELL, AMY JENNIFER
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:JENNIFER
Last Name:PARNELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 ROSWELL RD APT 28A8
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-5040
Mailing Address - Country:US
Mailing Address - Phone:318-436-6363
Mailing Address - Fax:
Practice Address - Street 1:1100 REINHARDT COLLEGE PKWY
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-2011
Practice Address - Country:US
Practice Address - Phone:770-575-8509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-11
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP008858235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist