Provider Demographics
NPI:1720694615
Name:ANDERSON, AMBER RAE (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:AMBER
Middle Name:RAE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8310 SW 204TH CT
Mailing Address - Street 2:
Mailing Address - City:DUNNELLON
Mailing Address - State:FL
Mailing Address - Zip Code:34431-5268
Mailing Address - Country:US
Mailing Address - Phone:352-427-6579
Mailing Address - Fax:
Practice Address - Street 1:8310 SW 204TH CT
Practice Address - Street 2:
Practice Address - City:DUNNELLON
Practice Address - State:FL
Practice Address - Zip Code:34431-5268
Practice Address - Country:US
Practice Address - Phone:352-427-6579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA18180235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist