Provider Demographics
NPI:1205958592
Name:DISHMAN, AMBER J (SLP)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:J
Last Name:DISHMAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 W CANAL ST # 862
Mailing Address - Street 2:
Mailing Address - City:ANSONIA
Mailing Address - State:OH
Mailing Address - Zip Code:45303-5154
Mailing Address - Country:US
Mailing Address - Phone:765-748-7834
Mailing Address - Fax:
Practice Address - Street 1:750 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:OH
Practice Address - Zip Code:45331-1312
Practice Address - Country:US
Practice Address - Phone:937-547-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004236A235Z00000X
OH11442235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist