Provider Demographics
NPI:1881678431
Name:IRVIN, AMBER (MCD, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:
Last Name:IRVIN
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 NIMS SPRING DR
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-6461
Mailing Address - Country:US
Mailing Address - Phone:803-230-8902
Mailing Address - Fax:
Practice Address - Street 1:147 NIMS SPRING DR
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-6461
Practice Address - Country:US
Practice Address - Phone:803-230-8902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist