Provider Demographics
NPI:1467138123
Name:SURRATT, AMBER DELAINE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:DELAINE
Last Name:SURRATT
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 SHINNECOCK HILLS LN APT 538
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-7416
Mailing Address - Country:US
Mailing Address - Phone:336-987-2620
Mailing Address - Fax:
Practice Address - Street 1:909 SHINNECOCK HILLS LN APT 538
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-7416
Practice Address - Country:US
Practice Address - Phone:336-987-2620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP012262235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist