Provider Demographics
NPI:1427586601
Name:EBERHARDT, AMBRY NICOLE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AMBRY
Middle Name:NICOLE
Last Name:EBERHARDT
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:AMBRY
Other - Middle Name:NICOLE
Other - Last Name:ROBERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:3500 DEPAUW BLVD STE 3070
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6135
Mailing Address - Country:US
Mailing Address - Phone:855-324-0885
Mailing Address - Fax:317-520-8200
Practice Address - Street 1:175 MARKET PLACE DR STE A
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40229-4471
Practice Address - Country:US
Practice Address - Phone:502-251-7002
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2017-06-01
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY262776235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty