Provider Demographics
NPI:1144385584
Name:NELSON, AMY LEIGH (MS,CF-SLP)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LEIGH
Last Name:NELSON
Suffix:
Gender:F
Credentials:MS,CF-SLP
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:LEIGH
Other - Last Name:LAZZAROTTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,CF-SLP
Mailing Address - Street 1:7438 SYCAMORE CT
Mailing Address - Street 2:APARTMENT 2 SW
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-4384
Mailing Address - Country:US
Mailing Address - Phone:815-922-9826
Mailing Address - Fax:
Practice Address - Street 1:1055 175TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-4610
Practice Address - Country:US
Practice Address - Phone:312-238-2155
Practice Address - Fax:708-957-8353
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
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