Provider Demographics
NPI:1407547516
Name:POORE, AMY SKAGGS (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:SKAGGS
Last Name:POORE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:MARIE
Other - Last Name:SKAGGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:3906 AVENUE T
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77550-8643
Mailing Address - Country:US
Mailing Address - Phone:409-761-3922
Mailing Address - Fax:
Practice Address - Street 1:3906 AVENUE T
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77550-8643
Practice Address - Country:US
Practice Address - Phone:409-761-3922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118738235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist