Provider Demographics
NPI:1568580090
Name:LISTER, AMY (MS, CCC, SLP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:LISTER
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 1:12 ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:MERRIMACK
Mailing Address - State:NH
Mailing Address - Zip Code:03054-7020
Mailing Address - Country:US
Mailing Address - Phone:603-566-4730
Mailing Address - Fax:603-262-5816
Practice Address - Street 1:12 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:MERRIMACK
Practice Address - State:NH
Practice Address - Zip Code:03054-7020
Practice Address - Country:US
Practice Address - Phone:603-566-4730
Practice Address - Fax:603-262-5816
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0939235Z00000X
MA6600235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist