Individual provider Active NPI

Amber Henry, M.ED., CCC-SLP

  • Speech-Language Pathologist
  • Eagle River, AK
National Provider Identifier
1649698721
Registry record updated Aug 14, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
74 Issued in AK
Practice address
10928 Eagle River Rd Ste 104
Eagle River, AK 99577-8079
Phone
(907) 622-2122
Fax
(855) 368-5399
NPI assigned
Apr 4, 2014
Last updated
Aug 14, 2019By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 14, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 74 AK Primary

Addresses

Primary practice location

10928 Eagle River Rd Ste 104
Eagle River, AK 99577-8079

Mailing address

10928 Eagle River Rd
Eagle River, AK 99577-8078
Phone (907) 622-2122

Other practice location 1

10928 Eagle River Rd Ste 104
Eagle River, AK 99577-8079
Phone (907) 622-2122

Other identifiers 1

IdentifierTypeStateIssuer
1675767MedicaidAK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Education

State licenses

LicenseStateTypeSpecialty
74AKMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Firm Foundation Therapy & Wellness, LLC Speech-Language Pathologist Current Accepting new patients

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1396569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565740800000",
    "number": "1649698721",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10928 EAGLE RIVER RD",
            "city": "EAGLE RIVER",
            "state": "AK",
            "postal_code": "995778078",
            "telephone_number": "907-622-2122",
            "fax_number": "855-368-5399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10928 EAGLE RIVER RD STE 104",
            "city": "EAGLE RIVER",
            "state": "AK",
            "postal_code": "995778079",
            "telephone_number": "907-622-2122",
            "fax_number": "855-368-5399"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10928 Eagle River Rd Ste 104",
            "address_purpose": "LOCATION",
            "city": "Eagle River",
            "state": "AK",
            "postal_code": "995778079",
            "country_code": "US",
            "telephone_number": "907-622-2122",
            "fax_number": "855-368-5399",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HENRY",
        "first_name": "AMBER",
        "credential": "M.ED., CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-04-04",
        "last_updated": "2019-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "AK",
            "license": "74",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1675767",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Eagle River, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2019; 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.