Provider Demographics
NPI:1205376142
Name:FRITCHMAN, AMELIA HARPER (MED CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:HARPER
Last Name:FRITCHMAN
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 PARKWOOD DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4758
Mailing Address - Country:US
Mailing Address - Phone:912-996-2069
Mailing Address - Fax:912-265-0041
Practice Address - Street 1:2601 PARKWOOD DR
Practice Address - Street 2:SUITE E
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4758
Practice Address - Country:US
Practice Address - Phone:912-996-2069
Practice Address - Fax:912-265-0041
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-25
Last Update Date:2017-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP003727235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist