Provider Demographics
NPI:1154780898
Name:MASON, AMY (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:MASON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51950 HAZEL RD
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-9268
Mailing Address - Country:US
Mailing Address - Phone:812-374-7755
Mailing Address - Fax:
Practice Address - Street 1:51950 HAZEL RD
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-9268
Practice Address - Country:US
Practice Address - Phone:812-374-7755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN14086029235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist