Provider Demographics
NPI:1467702647
Name:AMSHOFF, KERRY LACEY (MA, CFY-SLP)
Entity Type:Individual
Prefix:MS
First Name:KERRY
Middle Name:LACEY
Last Name:AMSHOFF
Suffix:
Gender:F
Credentials:MA, CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10113 NORTHWIND DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-9591
Mailing Address - Country:US
Mailing Address - Phone:317-750-7886
Mailing Address - Fax:
Practice Address - Street 1:11699 MAPLE ST
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-2805
Practice Address - Country:US
Practice Address - Phone:317-284-1166
Practice Address - Fax:317-284-1669
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN46002386A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist