Provider Demographics
NPI:1457807505
Name:DETTER, AMBER (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:DETTER
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 1:4003 RAYNOR PKWY
Mailing Address - Street 2:1313
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-6116
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4003 RAYNOR PKWY
Practice Address - Street 2:1313
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-6116
Practice Address - Country:US
Practice Address - Phone:402-239-0451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-29
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1835235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist