Provider Demographics
NPI:1356403604
Name:MAFFUCCI, AMY WHITE (MSP, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:WHITE
Last Name:MAFFUCCI
Suffix:
Gender:F
Credentials:MSP, CCC-SLP
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Mailing Address - Street 1:9129 MONROE RD
Mailing Address - Street 2:SUITE 100-105
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-2429
Mailing Address - Country:US
Mailing Address - Phone:704-847-3911
Mailing Address - Fax:704-847-2033
Practice Address - Street 1:9129 MONROE RD
Practice Address - Street 2:SUITE 100-105
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28270-2429
Practice Address - Country:US
Practice Address - Phone:704-847-3911
Practice Address - Fax:704-847-2033
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2013-06-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC7770235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1465MOtherBCBS
NC7412770Medicaid