Provider Demographics
NPI:1043463920
Name:RICKARD, AMY MCLEOD (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MCLEOD
Last Name:RICKARD
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 OXFORD RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12569-6981
Mailing Address - Country:US
Mailing Address - Phone:845-797-2276
Mailing Address - Fax:
Practice Address - Street 1:75 OXFORD RD
Practice Address - Street 2:
Practice Address - City:PLEASANT VALLEY
Practice Address - State:NY
Practice Address - Zip Code:12569-6981
Practice Address - Country:US
Practice Address - Phone:845-797-2276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-23
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013324-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist