Provider Demographics
NPI:1790817138
Name:KISER, AMBER G (PHD)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:G
Last Name:KISER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:M
Other - Last Name:GARDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PDD
Mailing Address - Street 1:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:415 RAY C HUNT DR STE 1200
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-2980
Practice Address - Country:US
Practice Address - Phone:434-924-2050
Practice Address - Fax:434-243-5207
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201001224231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010040531Medicaid
VA010040531Medicaid
VA003213U56Medicare PIN