Provider Demographics
NPI:1912643768
Name:REDDING, AMY L (MED CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:L
Last Name:REDDING
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:MRS
Other - First Name:AMY
Other - Middle Name:L
Other - Last Name:BRIGHTWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3470 N VALDOSTA RD STE C
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1050
Mailing Address - Country:US
Mailing Address - Phone:229-292-1945
Mailing Address - Fax:888-450-0379
Practice Address - Street 1:3470 N VALDOSTA RD STE C
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1050
Practice Address - Country:US
Practice Address - Phone:229-292-1945
Practice Address - Fax:888-450-0379
Is Sole Proprietor?:No
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP012041235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist