Provider Demographics
NPI:1568751212
Name:GILES, AMY ELAINE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:ELAINE
Last Name:GILES
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 BROWNING CT
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:GA
Mailing Address - Zip Code:31763-7214
Mailing Address - Country:US
Mailing Address - Phone:229-344-3999
Mailing Address - Fax:229-436-1062
Practice Address - Street 1:119 BROWNING CT
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:GA
Practice Address - Zip Code:31763-7214
Practice Address - Country:US
Practice Address - Phone:229-344-3999
Practice Address - Fax:229-436-1062
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006789235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist