Provider Demographics
NPI:1285835686
Name:CHILDRESS, AMY YVONNE (MA, ED, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:YVONNE
Last Name:CHILDRESS
Suffix:
Gender:F
Credentials:MA, ED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:643 SWEETWATER RD.
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:KY
Mailing Address - Zip Code:40403
Mailing Address - Country:US
Mailing Address - Phone:606-308-5396
Mailing Address - Fax:
Practice Address - Street 1:643 SWEETWATER RD.
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403
Practice Address - Country:US
Practice Address - Phone:606-308-5396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2373235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY01862OtherPROVIDER # FIRST STEPS