Provider Demographics
NPI:1538311030
Name:LINCOLN, AMY ELLEN (PHD, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:ELLEN
Last Name:LINCOLN
Suffix:
Gender:F
Credentials:PHD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2962 SENTINEL DR
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-8724
Mailing Address - Country:US
Mailing Address - Phone:406-587-4252
Mailing Address - Fax:
Practice Address - Street 1:612 E MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3726
Practice Address - Country:US
Practice Address - Phone:406-522-3722
Practice Address - Fax:406-522-0018
Is Sole Proprietor?:No
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1195235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist