Provider Demographics
NPI:1114179488
Name:SOULE, AMY S (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:S
Last Name:SOULE
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 1:56225 STATE HIGHWAY 10
Mailing Address - Street 2:
Mailing Address - City:BLOOMVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13739-2154
Mailing Address - Country:US
Mailing Address - Phone:607-287-9144
Mailing Address - Fax:
Practice Address - Street 1:99 MAIN ST
Practice Address - Street 2:
Practice Address - City:DELHI
Practice Address - State:NY
Practice Address - Zip Code:13753-1221
Practice Address - Country:US
Practice Address - Phone:607-832-5200
Practice Address - Fax:607-832-5202
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-18
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017962-1235Z00000X
NC10966235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist