Provider Demographics
NPI:1316073000
Name:WEST, AMBER RAE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:RAE
Last Name:WEST
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:RAE
Other - Last Name:TINCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:1002 RUSTLING RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25303-2725
Mailing Address - Country:US
Mailing Address - Phone:304-550-6965
Mailing Address - Fax:
Practice Address - Street 1:1002 RUSTLING RD
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25303-2725
Practice Address - Country:US
Practice Address - Phone:304-550-6965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP-1034235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810007148Medicaid