Provider Demographics
NPI:1184748402
Name:TIPTON, AMY PERRY (MACCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:PERRY
Last Name:TIPTON
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15D QUAIL DR
Mailing Address - Street 2:
Mailing Address - City:ONA
Mailing Address - State:WV
Mailing Address - Zip Code:25545-9521
Mailing Address - Country:US
Mailing Address - Phone:304-733-1997
Mailing Address - Fax:304-733-2593
Practice Address - Street 1:101 13TH ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-1653
Practice Address - Country:US
Practice Address - Phone:304-525-7622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV0639235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist