Provider Demographics
NPI:1346656931
Name:PRINCE, AMY (MA-CCC, SLP, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:PRINCE
Suffix:
Gender:F
Credentials:MA-CCC, SLP, BCBA
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:MICHELLE
Other - Last Name:WIECHMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2118 W SAN JOSE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-2835
Mailing Address - Country:US
Mailing Address - Phone:559-288-7343
Mailing Address - Fax:
Practice Address - Street 1:7257 N MAPLE AVE STE 107
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-0167
Practice Address - Country:US
Practice Address - Phone:559-549-7343
Practice Address - Fax:559-549-6261
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-03
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13262235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist