1174863104 NPI number — MRS. AMY LYNN ARNETT M.S., CCC-A

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174863104 NPI number — MRS. AMY LYNN ARNETT M.S., CCC-A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARNETT
Provider First Name:
AMY
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S., CCC-A
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TYNER
Provider Other First Name:
AMY
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S., CCC-A
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1174863104
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2135 THORNBURY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALLEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75013-5368
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-332-8918
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17390 PRESTON RD
Provider Second Line Business Practice Location Address:
SUITE 320
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75252-5795
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-733-3344
Provider Business Practice Location Address Fax Number:
972-733-3852
Provider Enumeration Date:
02/28/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  80448 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 336791 . This is a "PTAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 80448 . This is a "TEXAS AUDIOLOGY LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 09115371 . This is a "AMERICAN SPEECH LANGUAGE AND HEARING ASSOCIATION" identifier . This identifiers is of the category "OTHER".




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