Provider Demographics
NPI:1447566138
Name:PAPPALARDO, AMY LOUISE SAMPLE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LOUISE SAMPLE
Last Name:PAPPALARDO
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 LYNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-9422
Mailing Address - Country:US
Mailing Address - Phone:336-392-7775
Mailing Address - Fax:
Practice Address - Street 1:2020 LYNWOOD DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-9422
Practice Address - Country:US
Practice Address - Phone:336-392-7775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8214235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8214OtherSTATE LICENSURE NUMBER
12117153OtherASHA ASSOC. NUMBER