Provider Demographics
NPI:1821369992
Name:SPANGLER, AMIE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AMIE
Middle Name:
Last Name:SPANGLER
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 1:4554 W 48TH ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:MI
Mailing Address - Zip Code:49412-8721
Mailing Address - Country:US
Mailing Address - Phone:231-924-3990
Mailing Address - Fax:
Practice Address - Street 1:4554 W 48TH ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:MI
Practice Address - Zip Code:49412-8721
Practice Address - Country:US
Practice Address - Phone:231-924-3990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-22
Last Update Date:2012-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI12145253235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist