Provider Demographics
NPI:1649477431
Name:ROSE, AMY (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2715 CAMDEN RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-1438
Mailing Address - Country:US
Mailing Address - Phone:336-854-9963
Mailing Address - Fax:
Practice Address - Street 1:408 WESLEY RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-6405
Practice Address - Country:US
Practice Address - Phone:252-756-1800
Practice Address - Fax:252-756-1885
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6139235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist