Provider Demographics
NPI:1861864530
Name:NABORS, AMY POLUMBO (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:POLUMBO
Last Name:NABORS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
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Mailing Address - Street 1:1211 UNION AVE STE 330
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-6655
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1325 EASTMORELAND AVE STE 260
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-7549
Practice Address - Country:US
Practice Address - Phone:901-272-6051
Practice Address - Fax:901-266-6443
Is Sole Proprietor?:No
Enumeration Date:2015-10-21
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5136235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1861864530Medicaid
MS03103531Medicaid
TNQ034213Medicaid