Individual provider Active NPI

Amy Perez, MS, CCC-SLP

  • Speech-Language Pathologist
  • Chesapeake, VA
National Provider Identifier
1770728693
Registry record updated Dec 5, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
2202005170 Issued in VA
Practice address
4016 Raintree Rd
Suite 240
Chesapeake, VA 23321-3700
Phone
(757) 488-2864
Fax
(757) 488-4735
NPI assigned
Dec 5, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2008

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 2202005170 VA Primary

Addresses

Primary practice location

4016 Raintree Rd
Suite 240
Chesapeake, VA 23321-3700

Mailing address

4016 Raintree Rd
Suite 240
Chesapeake, VA 23321-3700
Phone (757) 488-2864

Other identifiers 1

IdentifierTypeStateIssuer
004979061MedicaidVA

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 Science

State licenses

LicenseStateTypeSpecialty
2202005170VAMDSpeech-Language Pathologist

NPI Registry JSON

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

{
    "created_epoch": "1228435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1228435200000",
    "number": "1770728693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4016 RAINTREE RD",
            "address_2": "SUITE 240",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233213700",
            "telephone_number": "757-488-2864",
            "fax_number": "757-488-4735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4016 RAINTREE RD",
            "address_2": "SUITE 240",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233213700",
            "telephone_number": "757-488-2864",
            "fax_number": "757-488-4735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEREZ",
        "first_name": "AMY",
        "credential": "MS, CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-12-05",
        "last_updated": "2008-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "VA",
            "license": "2202005170",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004979061",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chesapeake, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2008; 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.