Provider Demographics
NPI:1568700045
Name:GARRETT, AMBER DEVAN (M ED CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:DEVAN
Last Name:GARRETT
Suffix:
Gender:F
Credentials:M ED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 WALLACE CIR
Mailing Address - Street 2:
Mailing Address - City:EASTMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31023-2300
Mailing Address - Country:US
Mailing Address - Phone:478-231-8399
Mailing Address - Fax:
Practice Address - Street 1:55 WALLACE CIR
Practice Address - Street 2:
Practice Address - City:EASTMAN
Practice Address - State:GA
Practice Address - Zip Code:31023-2300
Practice Address - Country:US
Practice Address - Phone:478-231-8399
Practice Address - Fax:888-979-8343
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-18
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP008153235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist