Provider Demographics
NPI:1205120409
Name:DEAN, AMI CHERITH (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:AMI
Middle Name:CHERITH
Last Name:DEAN
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 1:620 MAGNA CARTA VIA
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBRG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-1470
Mailing Address - Country:US
Mailing Address - Phone:540-616-7260
Mailing Address - Fax:
Practice Address - Street 1:620 MAGNA CARTA VIA
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBRG
Practice Address - State:VA
Practice Address - Zip Code:24073-1470
Practice Address - Country:US
Practice Address - Phone:540-616-7260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30000075235Z00000X
VA2202006309235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1205120409Medicaid
VA30016196820002Medicaid