Provider Demographics
NPI:1750158945
Name:WINDHAM, AMIE NICOLE (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:AMIE
Middle Name:NICOLE
Last Name:WINDHAM
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 1:8461B KING RD
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39305-3505
Mailing Address - Country:US
Mailing Address - Phone:601-917-9748
Mailing Address - Fax:
Practice Address - Street 1:6600 POPLAR SPRINGS DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39305-1105
Practice Address - Country:US
Practice Address - Phone:601-482-5561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS4290235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist