Provider Demographics
NPI:1205962545
Name:CLEGHORN, AMBER LEE (AUD, CCC-A)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:LEE
Last Name:CLEGHORN
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 HEMLOCK ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-3202
Mailing Address - Country:US
Mailing Address - Phone:478-741-1800
Mailing Address - Fax:
Practice Address - Street 1:540 HEMLOCK ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-3202
Practice Address - Country:US
Practice Address - Phone:478-741-1800
Practice Address - Fax:478-743-8383
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3783231H00000X
231HA2400X, 231HA2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA852365468AMedicaid
GA511I640021Medicare UPIN