Provider Demographics
NPI:1750453551
Name:PARKS, AMY MARIE (MS CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:MARIE
Last Name:PARKS
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 CUMBERLAND STREET
Mailing Address - Street 2:SEVEN HILLS RHODE ISLAND
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895
Mailing Address - Country:US
Mailing Address - Phone:401-775-1500
Mailing Address - Fax:
Practice Address - Street 1:30 CUMBERLAND STREET
Practice Address - Street 2:SEVEN HILLS RHODE ISLAND
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895
Practice Address - Country:US
Practice Address - Phone:401-775-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIKC02260Medicaid
RI413068OtherBLUE CHIP
RI4224OtherNEIGHBORHOOD HEALTH
RI0177OtherNEIGHBORHOOD HEALTH
RI309329OtherBCBS
RI4600113OtherUNITED HEALTHCARE