Provider Demographics
NPI:1215065289
Name:ANDERSON, AMBER D (MSCCC-SLP/L)
Entity type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:D
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MSCCC-SLP/L
Other - Prefix:MS
Other - First Name:AMBER
Other - Middle Name:D
Other - Last Name:BONGIORNO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSCCC-SLP/L
Mailing Address - Street 1:2400 DARLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:BEAVER FALLS
Mailing Address - State:PA
Mailing Address - Zip Code:15010-1305
Mailing Address - Country:US
Mailing Address - Phone:724-846-8255
Mailing Address - Fax:724-647-1232
Practice Address - Street 1:2400 DARLINGTON RD
Practice Address - Street 2:
Practice Address - City:BEAVER FALLS
Practice Address - State:PA
Practice Address - Zip Code:15010-1305
Practice Address - Country:US
Practice Address - Phone:724-846-8255
Practice Address - Fax:724-647-1232
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL008545235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1021738000002Medicaid