Provider Demographics
NPI:1396950366
Name:ECCLESTON, AMY ELIZABETH (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:ELIZABETH
Last Name:ECCLESTON
Suffix:
Gender:F
Credentials:MS CCC-SLP
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Mailing Address - Street 1:920 EMERALD SOUND BLVD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-2230
Mailing Address - Country:US
Mailing Address - Phone:469-855-0462
Mailing Address - Fax:940-365-0763
Practice Address - Street 1:920 EMERALD SOUND BLVD
Practice Address - Street 2:
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-2230
Practice Address - Country:US
Practice Address - Phone:469-855-0462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-13
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19661235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist