Provider Demographics
NPI:1174209027
Name:FAWCETT, AMELIA CATHERINE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:CATHERINE
Last Name:FAWCETT
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:CATHERINE
Other - Last Name:MCMURTRAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:26 PITTSBURGH CIRCLE
Mailing Address - Street 2:
Mailing Address - City:ELLWOOD CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16117
Mailing Address - Country:US
Mailing Address - Phone:724-752-1551
Mailing Address - Fax:
Practice Address - Street 1:26 PITTSBURGH CIRCLE
Practice Address - Street 2:
Practice Address - City:ELLWOOD CITY
Practice Address - State:PA
Practice Address - Zip Code:16117
Practice Address - Country:US
Practice Address - Phone:724-752-1551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-26
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL016999235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist