Provider Demographics
NPI:1063582963
Name:FRANTZ, AMBER VIRGINIA (SLP)
Entity type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:VIRGINIA
Last Name:FRANTZ
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 N 160TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68118-2472
Mailing Address - Country:US
Mailing Address - Phone:314-288-7046
Mailing Address - Fax:
Practice Address - Street 1:3420 N 78TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-5038
Practice Address - Country:US
Practice Address - Phone:402-572-9072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5600235Z00000X
MO2007024359235Z00000X
NE1638235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2007024359OtherLICENSE #
NC7260OtherLICENSE#
MO12083021OtherASHA