Provider Demographics
NPI:1578864120
Name:MINOR, AMY L (MA CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:L
Last Name:MINOR
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 S MUSTANG RD
Mailing Address - Street 2:
Mailing Address - City:BLANCHARD
Mailing Address - State:OK
Mailing Address - Zip Code:73010-6637
Mailing Address - Country:US
Mailing Address - Phone:405-301-6238
Mailing Address - Fax:
Practice Address - Street 1:1051 S MUSTANG RD
Practice Address - Street 2:
Practice Address - City:BLANCHARD
Practice Address - State:OK
Practice Address - Zip Code:73010-6637
Practice Address - Country:US
Practice Address - Phone:405-301-6238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-14
Last Update Date:2010-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3586235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist