Amber Libby, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SLP009227 Issued in GA

Practice address

212 NE Broad St
Jesup, GA 31546-4371

Phone

(912) 342-8875

Fax

(912) 342-8016

NPI assigned

Dec 27, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Pediatric Therapies of SE Ga, LLC

  • Pediatric Occupational Therapist
  • Brunswick, GA
  • NPI 1841577111

  Multi-Specialty

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1640563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640563200000",
    "number": "1104586502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4212 CORAL PARK DR",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315203016",
            "telephone_number": "912-342-8875",
            "fax_number": "912-342-8016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 NE BROAD ST",
            "city": "JESUP",
            "state": "GA",
            "postal_code": "315464371",
            "telephone_number": "912-342-8875",
            "fax_number": "912-342-8016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIBBY",
        "first_name": "AMBER",
        "credential": "CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-12-27",
        "last_updated": "2021-12-27",
        "certification_date": "2021-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "SLP009227",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Randy Lentz, M.D.
• Nicole Levitt
• Amber Lewis, PTA
• Beth A Lewis, FNP-C
• Robin Angela Lewis
• Franklin Maxwell Linder
• William Ashley Linder, DOCTORATE PHARMACY
• Christina Little, RBT
• Jeri Lynn Long, APRN
• Thomas Patrick Loumeau, MD

• Speech-Language Pathologist in Jesup, GA
• Providers in Jesup, GA by specialty
• Speech-Language Pathologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.