Provider Demographics
NPI:1336279876
Name:LEVINE, AMY MARIE (MS CCC SLP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:LEVINE
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:MARIE
Other - Last Name:TREDINNICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:31 KILLINGWORTH TPKE
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:CT
Mailing Address - Zip Code:06413-1327
Mailing Address - Country:US
Mailing Address - Phone:203-230-2815
Mailing Address - Fax:203-230-8502
Practice Address - Street 1:1450 CHAPEL ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4405
Practice Address - Country:US
Practice Address - Phone:203-789-3362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001866235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001866OtherLICENSE #