Provider Demographics
NPI:1184881880
Name:BUCKNER, AMY T (MCD CCC A)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:T
Last Name:BUCKNER
Suffix:
Gender:F
Credentials:MCD CCC A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5204 W REDBUD ST
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8936
Mailing Address - Country:US
Mailing Address - Phone:479-636-0110
Mailing Address - Fax:479-631-0491
Practice Address - Street 1:5204 W REDBUD ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8936
Practice Address - Country:US
Practice Address - Phone:479-636-0110
Practice Address - Fax:479-631-0491
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA#83231H00000X
TX80548231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist