Provider Demographics
NPI:1285893768
Name:SHOLLENBARGER, AMY JO (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:JO
Last Name:SHOLLENBARGER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 FINCH RD
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-6237
Mailing Address - Country:US
Mailing Address - Phone:870-236-9118
Mailing Address - Fax:
Practice Address - Street 1:1501 W COURT ST
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-4025
Practice Address - Country:US
Practice Address - Phone:870-239-3885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#1184235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist