Provider Demographics
NPI:1275981383
Name:FENSCH, AMY LYNN (PC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:FENSCH
Suffix:
Gender:F
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6235 OLD WILLIAM PENN HWY
Mailing Address - Street 2:
Mailing Address - City:EXPORT
Mailing Address - State:PA
Mailing Address - Zip Code:15632-2517
Mailing Address - Country:US
Mailing Address - Phone:724-875-7064
Mailing Address - Fax:
Practice Address - Street 1:6235 OLD WILLIAM PENN HWY
Practice Address - Street 2:
Practice Address - City:EXPORT
Practice Address - State:PA
Practice Address - Zip Code:15632-2517
Practice Address - Country:US
Practice Address - Phone:724-875-7064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC008747101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional