Individual
AMY ELLIOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.ED.,CCC-SLP
Contact information
Practice address
185 CHARLOIS BLVD, WINSTON SALEM, NC 27103-1521
(336) 725-0222
(336) 725-0454
Mailing address
185 CHARLOIS BLVD, WINSTON SALEM, NC 27103-1521
(336) 725-0222
(336) 725-0454
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
7640
NC
235Z00000X
Speech-Language Pathologist
SLP004977
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10035709
—
GA
05
—
305494
—
GA
01
—
52868995-001
BLUE CROSS BLUE SHIELD
GA
Enumeration date
11/28/2006
Last updated
01/22/2008
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