Provider Demographics
NPI:1790931236
Name:BASS, AMBER CAMILLE (AUD, CCC-A)
Entity Type:Individual
Prefix:DR
First Name:AMBER
Middle Name:CAMILLE
Last Name:BASS
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:CAMILLE
Other - Last Name:FRANKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1180 SETON PKWY
Mailing Address - Street 2:SUITE 420
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-6178
Mailing Address - Country:US
Mailing Address - Phone:512-268-5282
Mailing Address - Fax:512-268-5769
Practice Address - Street 1:1180 SETON PKWY
Practice Address - Street 2:SUITE 420
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-6178
Practice Address - Country:US
Practice Address - Phone:512-268-5282
Practice Address - Fax:512-268-5769
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1435231H00000X, 237600000X
TX80444231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80781AOtherBCBS-AENTC
TX301447401Medicaid
TX80782AOtherBCBS-HCAENTC
TXTXB147563Medicare PIN
TX80781AOtherBCBS-AENTC