Provider Demographics
NPI:1194144527
Name:GAMBER, AMY (BS)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:GAMBER
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4225 SASSAFRAS LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-2109
Mailing Address - Country:US
Mailing Address - Phone:618-214-0814
Mailing Address - Fax:
Practice Address - Street 1:4225 SASSAFRAS LN
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-2109
Practice Address - Country:US
Practice Address - Phone:618-214-0814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-14
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist