Provider Demographics
NPI:1831289917
Name:WALLACE, AMY PIATT (MSR,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:PIATT
Last Name:WALLACE
Suffix:
Gender:F
Credentials:MSR,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 CURETON ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-1031
Mailing Address - Country:US
Mailing Address - Phone:864-232-5895
Mailing Address - Fax:
Practice Address - Street 1:238 CURETON ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-1031
Practice Address - Country:US
Practice Address - Phone:864-232-5895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3478235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist