Provider Demographics
NPI:1417136169
Name:LEDERLE, AMY PAULINE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:PAULINE
Last Name:LEDERLE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 E 5TH ST
Mailing Address - Street 2:UNIT B
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-5070
Mailing Address - Country:US
Mailing Address - Phone:520-309-1965
Mailing Address - Fax:
Practice Address - Street 1:711 E 5TH ST
Practice Address - Street 2:UNIT B
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-5070
Practice Address - Country:US
Practice Address - Phone:520-309-1965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP5219235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist