Provider Demographics
NPI:1134585706
Name:SLATE, AMYE
Entity type:Individual
Prefix:
First Name:AMYE
Middle Name:
Last Name:SLATE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 CRAWFORD RD
Mailing Address - Street 2:
Mailing Address - City:SENOIA
Mailing Address - State:GA
Mailing Address - Zip Code:30276-2981
Mailing Address - Country:US
Mailing Address - Phone:770-331-4456
Mailing Address - Fax:
Practice Address - Street 1:7162 LONE OAK WAY
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-8291
Practice Address - Country:US
Practice Address - Phone:404-606-3755
Practice Address - Fax:877-730-2912
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-12
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP003736235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GASLP003736OtherGEORGIA STATE LICENSE