Provider Demographics
NPI:1740889674
Name:SHIPLEY, AMY ALLISON (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:ALLISON
Last Name:SHIPLEY
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2881 KAIWIKI RD
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-9729
Mailing Address - Country:US
Mailing Address - Phone:808-351-6741
Mailing Address - Fax:
Practice Address - Street 1:563 KAUMANA DR
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-1812
Practice Address - Country:US
Practice Address - Phone:808-498-0100
Practice Address - Fax:808-935-5801
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HISP-1534235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
14049954OtherAMERICAN SPEECH-LANGUAGE HEARING ASSOCIATION;
HISP-1534OtherSTATE OF HAWAII DEPARTMENT OF COMMERCE & CONSUMER AFFAIRS