Provider Demographics
NPI:1891553087
Name:ERVIN, AMBER DAWN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:DAWN
Last Name:ERVIN
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 1:603 C R RD
Mailing Address - Street 2:
Mailing Address - City:REEDSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26547-7020
Mailing Address - Country:US
Mailing Address - Phone:304-288-3763
Mailing Address - Fax:
Practice Address - Street 1:5258 S PRESTON HWY
Practice Address - Street 2:
Practice Address - City:TUNNELTON
Practice Address - State:WV
Practice Address - Zip Code:26444-7538
Practice Address - Country:US
Practice Address - Phone:304-568-2292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP-1167235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist