Individual
AMY KEITH BUNGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSCCCSLP
Contact information
Practice address
4328 BLAND RD, RALEIGH, NC 27609-6125
(919) 341-3894
Mailing address
4328 BLAND RD, RALEIGH, NC 27609-6125
(919) 341-3894
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
7717
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7717
STATE LICENSE
NC
Enumeration date
10/30/2007
Last updated
10/30/2007
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