Provider Demographics
NPI:1477072122
Name:AMOS, JASON LEE (MED CCC-SLP, CBIS)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:LEE
Last Name:AMOS
Suffix:
Gender:M
Credentials:MED CCC-SLP, CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3660 CHESTNUT RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-5101
Mailing Address - Country:US
Mailing Address - Phone:404-358-1473
Mailing Address - Fax:
Practice Address - Street 1:3660 CHESTNUT RIDGE COURT
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062
Practice Address - Country:US
Practice Address - Phone:404-358-1473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006080235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist