Provider Demographics
NPI:1538302526
Name:RANKIN, AMBER LOUISE
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:LOUISE
Last Name:RANKIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5807 PALMETTO DR
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34982-3220
Mailing Address - Country:US
Mailing Address - Phone:772-460-0919
Mailing Address - Fax:772-460-0505
Practice Address - Street 1:5807 PALMETTO DR
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34982-3220
Practice Address - Country:US
Practice Address - Phone:772-460-0919
Practice Address - Fax:772-460-0505
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA7952235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist