Provider Demographics
NPI:1205050192
Name:GILMER, AMARETTA MARIE (MS CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:AMARETTA
Middle Name:MARIE
Last Name:GILMER
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 1:4046 MCCONNELL CT
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62707-3018
Mailing Address - Country:US
Mailing Address - Phone:217-753-1213
Mailing Address - Fax:
Practice Address - Street 1:4046 MCCONNELL CT
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62707-3018
Practice Address - Country:US
Practice Address - Phone:217-753-1213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2010-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242000431235Z00000X
FLSA 10348235Z00000X
CA16668235Z00000X
WALL 60024121235Z00000X
TX104524235Z00000X
IN22004804A235Z00000X
MA7814235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist