Provider Demographics
NPI:1669141479
Name:THOMAS, AMY BETH (SLP)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:BETH
Last Name:THOMAS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 CANTRELL DR
Mailing Address - Street 2:
Mailing Address - City:COTTONTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37048-9669
Mailing Address - Country:US
Mailing Address - Phone:615-606-1617
Mailing Address - Fax:
Practice Address - Street 1:1421 CANTRELL DR
Practice Address - Street 2:
Practice Address - City:COTTONTOWN
Practice Address - State:TN
Practice Address - Zip Code:37048-9669
Practice Address - Country:US
Practice Address - Phone:615-606-1617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3938235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist