Provider Demographics
NPI:1427184928
Name:AMURGIS, CHRISTIE M (MA CCC SLP)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:M
Last Name:AMURGIS
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:CHRISTIE
Other - Middle Name:M
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC SLP
Mailing Address - Street 1:3602 W SAN JUAN ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-6922
Mailing Address - Country:US
Mailing Address - Phone:813-833-0090
Mailing Address - Fax:813-852-6373
Practice Address - Street 1:3602 W SAN JUAN ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-6922
Practice Address - Country:US
Practice Address - Phone:813-833-0090
Practice Address - Fax:813-852-6373
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
FLSA7425235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL889352700Medicaid