Provider Demographics
NPI:1811152309
Name:FOLEY, AMBER MARIE (SLP)
Entity type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:MARIE
Last Name:FOLEY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MISS
Other - First Name:AMBER
Other - Middle Name:MARIE
Other - Last Name:VAN LAERE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:53067 PRESTWICK CT
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-5855
Mailing Address - Country:US
Mailing Address - Phone:574-247-7500
Mailing Address - Fax:574-546-2023
Practice Address - Street 1:53067 PRESTWICK CT
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-5855
Practice Address - Country:US
Practice Address - Phone:574-247-7500
Practice Address - Fax:574-546-2023
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-23
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004351A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist