Provider Demographics
NPI:1053494906
Name:MOFFAT, AMY JANINE (MS)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:JANINE
Last Name:MOFFAT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:JANINE
Other - Last Name:GALASSI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:5045 SPAULDING ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62629-8728
Mailing Address - Country:US
Mailing Address - Phone:217-971-8795
Mailing Address - Fax:217-483-3508
Practice Address - Street 1:5045 SPAULDING ORCHARD RD
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:IL
Practice Address - Zip Code:62629-8728
Practice Address - Country:US
Practice Address - Phone:217-971-8795
Practice Address - Fax:217-483-3508
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist