Provider Demographics
NPI:1194473322
Name:GOLDSMITH, AMY MARIE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:GOLDSMITH
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12907 DEER CROSS DR
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-8117
Mailing Address - Country:US
Mailing Address - Phone:720-480-4799
Mailing Address - Fax:
Practice Address - Street 1:12907 DEER CROSS DR
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:KY
Practice Address - Zip Code:40059-8117
Practice Address - Country:US
Practice Address - Phone:720-480-4799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY246535235Z00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist