Provider Demographics
NPI:1316508997
Name:AMLONG, GARY
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:AMLONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2153
Mailing Address - Street 2:DEPT 8116
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35287-8116
Mailing Address - Country:US
Mailing Address - Phone:636-675-5471
Mailing Address - Fax:
Practice Address - Street 1:2820 DARDENNE LINKS DR
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-9741
Practice Address - Country:US
Practice Address - Phone:636-357-2951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-25
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist