Provider Demographics
NPI:1629327077
Name:DUNLAP, AMY NICOLE
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:NICOLE
Last Name:DUNLAP
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 1:465 CHELSEA PLACE AVE
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-0688
Mailing Address - Country:US
Mailing Address - Phone:410-294-2499
Mailing Address - Fax:
Practice Address - Street 1:393 PALM COAST PKWY SW
Practice Address - Street 2:SUITE 3
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-4773
Practice Address - Country:US
Practice Address - Phone:386-446-9935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-31
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 10889235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist