Provider Demographics
NPI:1538615976
Name:HISZEM, AMBER (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:
Last Name:HISZEM
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:853 BEECHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-2574
Mailing Address - Country:US
Mailing Address - Phone:330-805-1803
Mailing Address - Fax:
Practice Address - Street 1:420 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-2039
Practice Address - Country:US
Practice Address - Phone:330-945-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-26
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.11124235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist