Provider Demographics
NPI:1467866988
Name:INGRAM, AMY (AUD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:INGRAM
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 CORLEY MILL RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-7600
Mailing Address - Country:US
Mailing Address - Phone:803-256-2483
Mailing Address - Fax:803-799-4624
Practice Address - Street 1:218 SARAH WAY
Practice Address - Street 2:
Practice Address - City:KIMBERLY
Practice Address - State:AL
Practice Address - Zip Code:35091-3201
Practice Address - Country:US
Practice Address - Phone:205-908-4476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-12
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3998231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist