Provider Demographics
NPI:1689100448
Name:TERRY, AMY SUZANNE FOGLE (MCD CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:SUZANNE FOGLE
Last Name:TERRY
Suffix:
Gender:F
Credentials:MCD 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:PO BOX 784
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:SC
Mailing Address - Zip Code:29924-0784
Mailing Address - Country:US
Mailing Address - Phone:803-943-9434
Mailing Address - Fax:803-943-9454
Practice Address - Street 1:505 HOOVER ST S
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:SC
Practice Address - Zip Code:29924-2903
Practice Address - Country:US
Practice Address - Phone:803-943-9434
Practice Address - Fax:803-943-9454
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3927235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist