Provider Demographics
NPI:1831327188
Name:GIFFORD, AMBER MICHELLE
Entity type:Individual
Prefix:MISS
First Name:AMBER
Middle Name:MICHELLE
Last Name:GIFFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 SW 9TH ST
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:AR
Mailing Address - Zip Code:72422-3126
Mailing Address - Country:US
Mailing Address - Phone:870-926-5420
Mailing Address - Fax:870-634-2009
Practice Address - Street 1:600 W ELM ST
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:AR
Practice Address - Zip Code:72422-2722
Practice Address - Country:US
Practice Address - Phone:870-926-5420
Practice Address - Fax:870-634-2009
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-25
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
ARSP#2192235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist