Provider Demographics
NPI:1164756359
Name:HURT, AMY KLEINRICHERT (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:KLEINRICHERT
Last Name:HURT
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:KLEINRICHERT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:19977 NE MARIE AVE
Mailing Address - Street 2:
Mailing Address - City:BLOUNTSTOWN
Mailing Address - State:FL
Mailing Address - Zip Code:32424
Mailing Address - Country:US
Mailing Address - Phone:850-674-3885
Mailing Address - Fax:850-674-3885
Practice Address - Street 1:19977 N.E. MARIE AVE.
Practice Address - Street 2:
Practice Address - City:BLOUNTSTOWN
Practice Address - State:FL
Practice Address - Zip Code:32424
Practice Address - Country:US
Practice Address - Phone:850-674-3885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA10034235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist