Provider Demographics
NPI:1427433911
Name:DISBROW, AMBERLYN D (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:AMBERLYN
Middle Name:D
Last Name:DISBROW
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:AMBERLYN
Other - Middle Name:DEANNA
Other - Last Name:BUSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1701 PRUDENTIAL DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-8152
Mailing Address - Country:US
Mailing Address - Phone:904-381-3840
Mailing Address - Fax:
Practice Address - Street 1:1701 PRUDENTIAL DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8152
Practice Address - Country:US
Practice Address - Phone:904-381-3840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-25
Last Update Date:2015-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA12149235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist