Provider Demographics
NPI:1487091906
Name:EUBANKS, AMY DUKE (SLP)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:DUKE
Last Name:EUBANKS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 OLD BUSH RIVER RD
Mailing Address - Street 2:CHAPIN ELEMENTARY SCHOOL
Mailing Address - City:CHAPIN
Mailing Address - State:SC
Mailing Address - Zip Code:29036-8102
Mailing Address - Country:US
Mailing Address - Phone:803-575-5968
Mailing Address - Fax:
Practice Address - Street 1:940 OLD BUSH RIVER RD
Practice Address - Street 2:CHAPIN ELEMENTARY SCHOOL
Practice Address - City:CHAPIN
Practice Address - State:SC
Practice Address - Zip Code:29036-8102
Practice Address - Country:US
Practice Address - Phone:803-575-5968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-23
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
136919235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC136919Medicaid