Basic Information
Provider Information
NPI: 1417904764
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HOLLINGSWORTH
FirstName: AMBER
MiddleName: L
NamePrefix: DR.
NameSuffix:  
Credential: PH.D., CCC/SLP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6201 COLUMNS CIR
Address2:  
City: SEMINOLE
State: FL
PostalCode: 337726376
CountryCode: US
TelephoneNumber: 7273986661
FaxNumber: 7273191209
Practice Location
Address1: VAMC BAY PINES, AUDIOLOGY & SPEECH PATHOLOGY
Address2: 10000 BAY PINES BLVD
City: BAY PINES
State: FL
PostalCode: 33744
CountryCode: US
TelephoneNumber: 7273986661
FaxNumber: 7273191209
Other Information
ProviderEnumerationDate: 05/30/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
235Z00000XSA 6214FLY Speech, Language and Hearing Service ProvidersSpeech-Language Pathologist 

No ID Information.


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