Provider Demographics
NPI:1992820765
Name:GARRIS, AMBER SHAE (MA, CFY-SLP)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:SHAE
Last Name:GARRIS
Suffix:
Gender:F
Credentials:MA, CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3256 TIMBERWOLF AVE
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-9312
Mailing Address - Country:US
Mailing Address - Phone:336-508-3820
Mailing Address - Fax:
Practice Address - Street 1:901 BETHESDA RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3015
Practice Address - Country:US
Practice Address - Phone:336-768-2211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC703014235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist