Provider Demographics
NPI:1548400377
Name:BASSO, AMY (MS, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:BASSO
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:SOKOL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26 SALISBURY RD
Mailing Address - Street 2:
Mailing Address - City:PATTERSON
Mailing Address - State:NY
Mailing Address - Zip Code:12563-1207
Mailing Address - Country:US
Mailing Address - Phone:518-265-8315
Mailing Address - Fax:
Practice Address - Street 1:26 SALISBURY RD
Practice Address - Street 2:
Practice Address - City:PATTERSON
Practice Address - State:NY
Practice Address - Zip Code:12563-1207
Practice Address - Country:US
Practice Address - Phone:518-265-8315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-06
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015818 1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist