Provider Demographics
NPI:1427503960
Name:EMBER, AMANDA AERYN
Entity type:Individual
Prefix:
First Name:AMANDA AERYN
Middle Name:
Last Name:EMBER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9778 SPRINGHILL FARMS DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER
Mailing Address - State:AR
Mailing Address - Zip Code:72002-8998
Mailing Address - Country:US
Mailing Address - Phone:501-909-1470
Mailing Address - Fax:
Practice Address - Street 1:613 N HICKORY ST
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-4953
Practice Address - Country:US
Practice Address - Phone:501-909-1470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-24
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR226016721Medicaid