Provider Demographics
NPI:1467604975
Name:AMY C. HAVENOR
Entity Type:Organization
Organization Name:AMY C. HAVENOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:C
Authorized Official - Last Name:HAVENOR
Authorized Official - Suffix:
Authorized Official - Credentials:CCC/SLP
Authorized Official - Phone:972-387-1100
Mailing Address - Street 1:12880 HILLCREST RD STE 102
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-1501
Mailing Address - Country:US
Mailing Address - Phone:972-387-1100
Mailing Address - Fax:972-692-7332
Practice Address - Street 1:12880 HILLCREST RD STE 102
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-1501
Practice Address - Country:US
Practice Address - Phone:972-387-1100
Practice Address - Fax:972-692-7332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty