Provider Demographics
NPI:1326303041
Name:ROEHL, AMY CHRISTINE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:CHRISTINE
Last Name:ROEHL
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 1:1960 N DAMEN AVE
Mailing Address - Street 2:3
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-4565
Mailing Address - Country:US
Mailing Address - Phone:248-321-5836
Mailing Address - Fax:
Practice Address - Street 1:1960 N DAMEN AVE
Practice Address - Street 2:3
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-4565
Practice Address - Country:US
Practice Address - Phone:248-321-5836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.002026235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist