Provider Demographics
NPI:1730150186
Name:TEAGUE, AMIE MICHELLE (MA/CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:AMIE
Middle Name:MICHELLE
Last Name:TEAGUE
Suffix:
Gender:F
Credentials:MA/CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10864
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24543-5015
Mailing Address - Country:US
Mailing Address - Phone:434-228-1812
Mailing Address - Fax:866-468-5040
Practice Address - Street 1:159 EXECUTIVE DR STE A
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-4160
Practice Address - Country:US
Practice Address - Phone:434-228-1812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6794235Z00000X
VA2202003828235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA49-6720Medicare UPIN