Provider Demographics
NPI:1548695984
Name:DUPRE, AMBER CHANTE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:CHANTE
Last Name:DUPRE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:CHANTE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:510 E NORTH BROADWAY ST
Mailing Address - Street 2:COLUMBUS
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-4114
Mailing Address - Country:US
Mailing Address - Phone:614-263-5151
Mailing Address - Fax:614-263-5365
Practice Address - Street 1:510 E NORTH BROADWAY ST
Practice Address - Street 2:COLUMBUS
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-4114
Practice Address - Country:US
Practice Address - Phone:614-263-5151
Practice Address - Fax:614-263-5365
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.10790235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0094740Medicaid