Provider Demographics
NPI:1073169181
Name:MAPLETHORPE, AMY C
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:C
Last Name:MAPLETHORPE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 W PARK AVE
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60073-3226
Mailing Address - Country:US
Mailing Address - Phone:847-721-2692
Mailing Address - Fax:
Practice Address - Street 1:720 CENTRAL PARK DR
Practice Address - Street 2:
Practice Address - City:ROUND LAKE BEACH
Practice Address - State:IL
Practice Address - Zip Code:60073-2400
Practice Address - Country:US
Practice Address - Phone:847-270-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist