Provider Demographics
NPI:1285009134
Name:WAITE, AMY J (MA/CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:J
Last Name:WAITE
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 1:2433 MISTLETOE LN
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-4044
Mailing Address - Country:US
Mailing Address - Phone:678-863-5327
Mailing Address - Fax:
Practice Address - Street 1:2433 MISTLETOE LN
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039-4044
Practice Address - Country:US
Practice Address - Phone:678-863-5327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-03
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005210235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist