Basic Information
Provider Information
NPI: 1952498859
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RINGER
FirstName: AMY
MiddleName: BETH
NamePrefix:  
NameSuffix:  
Credential: MS/CCC, SLP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1432 DOGWOOD AVE
Address2:  
City: MORGANTOWN
State: WV
PostalCode: 265052310
CountryCode: US
TelephoneNumber: 3045982817
FaxNumber:  
Practice Location
Address1: 1085 VAN VOORHIS RD
Address2:  
City: MORGANTOWN
State: WV
PostalCode: 265053497
CountryCode: US
TelephoneNumber: 3045999250
FaxNumber: 3045999254
Other Information
ProviderEnumerationDate: 10/10/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
235Z00000XSLP-0695WVY Speech, Language and Hearing Service ProvidersSpeech-Language Pathologist 

ID Information
IDTypeStateIssuerDescription
9400144-00005WV MEDICAID


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