Provider Demographics
NPI:1245794577
Name:SEIDEL, AMBER JODENE
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:JODENE
Last Name:SEIDEL
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 1:1123 OXFORD CRES NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-1624
Mailing Address - Country:US
Mailing Address - Phone:404-247-7959
Mailing Address - Fax:404-393-2447
Practice Address - Street 1:1123 OXFORD CRES NE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30319-1624
Practice Address - Country:US
Practice Address - Phone:404-247-7959
Practice Address - Fax:404-393-2447
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005775235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist