Provider Demographics
NPI:1316937303
Name:AMOS, NATHAN E (PHD, CCC-A)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:E
Last Name:AMOS
Suffix:
Gender:M
Credentials:PHD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3838 S CLAYBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-4791
Mailing Address - Country:US
Mailing Address - Phone:812-330-8406
Mailing Address - Fax:812-855-7439
Practice Address - Street 1:200 S JORDAN AVE
Practice Address - Street 2:IU SPHS
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47405-7002
Practice Address - Country:US
Practice Address - Phone:812-855-7439
Practice Address - Fax:812-855-5561
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002135A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN545570Medicare ID - Type Unspecified