Provider Demographics
NPI:1518115922
Name:VANN, AMY RENE (MS, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:RENE
Last Name:VANN
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3704 HIGHWAY 377 S # A-B
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-9479
Mailing Address - Country:US
Mailing Address - Phone:817-560-1139
Mailing Address - Fax:
Practice Address - Street 1:3704 HIGHWAY 377 S # A-B
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-9479
Practice Address - Country:US
Practice Address - Phone:817-560-1139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16361235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist