Provider Demographics
NPI:1326463530
Name:ANDERSON CUNNINGHAM, AMY (MS, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:ANDERSON CUNNINGHAM
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 W KOENIG LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-1131
Mailing Address - Country:US
Mailing Address - Phone:512-467-7006
Mailing Address - Fax:
Practice Address - Street 1:2011 W KOENIG LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-1131
Practice Address - Country:US
Practice Address - Phone:512-467-7006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-25
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105124235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist