Provider Demographics
NPI:1003434382
Name:VALLEJOS, AMY NICOLE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:NICOLE
Last Name:VALLEJOS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 SPROULL AVE
Mailing Address - Street 2:
Mailing Address - City:WALSENBURG
Mailing Address - State:CO
Mailing Address - Zip Code:81089-1338
Mailing Address - Country:US
Mailing Address - Phone:719-989-0726
Mailing Address - Fax:
Practice Address - Street 1:615 RUSSELL STREET
Practice Address - Street 2:
Practice Address - City:WALSENBURG
Practice Address - State:CO
Practice Address - Zip Code:81089-2127
Practice Address - Country:US
Practice Address - Phone:719-695-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist