Individual
AMY SHROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M. ED., CCC-SLP
Contact information
Practice address
1912 MEMORIAL AVE, LYNCHBURG, VA 24501-1708
(434) 845-8765
Mailing address
PO BOX 2492, APPOMATTOX, VA 24522-2492
(434) 258-3976
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2202002228
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004978757
—
VA
01
—
078920
ANTHEM PROVIDER NUMBER
VA
Enumeration date
04/10/2006
Last updated
11/13/2024
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