Provider Demographics
NPI:1568617181
Name:DOUGHERTY, AMY E (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:E
Last Name:DOUGHERTY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2435 HIGHWAY 34 # 118B
Mailing Address - Street 2:
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-1819
Mailing Address - Country:US
Mailing Address - Phone:732-722-7570
Mailing Address - Fax:732-612-1046
Practice Address - Street 1:2568 ALGONKIN TRL
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-2330
Practice Address - Country:US
Practice Address - Phone:732-722-7570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJYS02924235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist