Provider Demographics
NPI:1275605156
Name:NEWSON, AMY (SA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:NEWSON
Suffix:
Gender:F
Credentials:SA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23123 98TH TER
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32060-5816
Mailing Address - Country:US
Mailing Address - Phone:386-658-5865
Mailing Address - Fax:386-658-5542
Practice Address - Street 1:10820 MARVIN E. JONES BLVD.
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32060
Practice Address - Country:US
Practice Address - Phone:386-658-5865
Practice Address - Fax:386-658-5542
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA6396235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist