Provider Demographics
NPI:1225673320
Name:FISCHETTI, AMY J (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:J
Last Name:FISCHETTI
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 1:10 FAWN PL
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-2116
Mailing Address - Country:US
Mailing Address - Phone:732-915-0425
Mailing Address - Fax:
Practice Address - Street 1:400 BELCHASE DR STE 406
Practice Address - Street 2:
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-9760
Practice Address - Country:US
Practice Address - Phone:732-851-6947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00228200235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty