Provider Demographics
NPI:1184043093
Name:LYKKE, AMY LEIGH (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LEIGH
Last Name:LYKKE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2246 S DAKOTA ST
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-5225
Mailing Address - Country:US
Mailing Address - Phone:406-299-3300
Mailing Address - Fax:
Practice Address - Street 1:2246 S DAKOTA ST
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-5225
Practice Address - Country:US
Practice Address - Phone:406-299-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-08
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTSLP-SP-LIC-3482235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist