Individual
AMY RANDOLPH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.ED., CCC-SLP
Contact information
Practice address
35 REFERENDUM DR NE, BOLIVIA, NC 28422-7578
(910) 406-5100
Mailing address
4974 KONA CT UNIT 2, SOUTHPORT, NC 28461-7576
(910) 599-6994
(704) 274-9212
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
5025
NC
235Z00000X
Speech-Language Pathologist
5639
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11945
BCBS PROVIDER #
NC
01
—
5025
NC LICENSE #
NC
01
—
7211429
MEDICAID GROUP PROVIDER #
NC
05
—
7411551
—
NC
Enumeration date
12/29/2007
Last updated
03/31/2026
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us