Provider Demographics
NPI:1578897005
Name:LYNCH, AMY RUTH (MA)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:RUTH
Last Name:LYNCH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 207
Mailing Address - Street 2:
Mailing Address - City:WAVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39576-0207
Mailing Address - Country:US
Mailing Address - Phone:228-254-0313
Mailing Address - Fax:
Practice Address - Street 1:518 AMELDA ST
Practice Address - Street 2:
Practice Address - City:WAVELAND
Practice Address - State:MS
Practice Address - Zip Code:39576-3202
Practice Address - Country:US
Practice Address - Phone:228-254-0313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-01
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS2936235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist