Provider Demographics
NPI:1164652574
Name:YODER, AMY D (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:D
Last Name:YODER
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 1:12910 CLYDESDALE CT
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46814-7490
Mailing Address - Country:US
Mailing Address - Phone:260-672-0268
Mailing Address - Fax:
Practice Address - Street 1:12910 CLYDESDALE CT
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46814-7490
Practice Address - Country:US
Practice Address - Phone:260-672-0268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004681A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist