Provider Demographics
NPI:1962556464
Name:MORROW, AMY LONG (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LONG
Last Name:MORROW
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 1:13405 SUMMIT HILLS RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-6545
Mailing Address - Country:US
Mailing Address - Phone:505-268-8414
Mailing Address - Fax:505-268-2035
Practice Address - Street 1:13405 SUMMIT HILLS RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-6545
Practice Address - Country:US
Practice Address - Phone:505-268-8414
Practice Address - Fax:505-268-2035
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1904235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000R8086Medicaid
NM000D4437Medicaid