Provider Demographics
NPI:1447424478
Name:STEVENSON, AMY (MA, CCC-A)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1724 HAMILL RD
Mailing Address - Street 2:OASIS PARK BUILDING I, SUITE 102
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-4905
Mailing Address - Country:US
Mailing Address - Phone:423-209-9111
Mailing Address - Fax:423-209-9106
Practice Address - Street 1:1724 HAMILL RD
Practice Address - Street 2:OASIS PARK BUILDING I, SUITE 102
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-4905
Practice Address - Country:US
Practice Address - Phone:423-209-9111
Practice Address - Fax:423-209-9106
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000001159231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist