Provider Demographics
NPI:1588676647
Name:ANDERECK, AMY A (MA-CCC/SLP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:A
Last Name:ANDERECK
Suffix:
Gender:F
Credentials:MA-CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12408 S HOBART ST
Mailing Address - Street 2:
Mailing Address - City:PALOS PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60464-1754
Mailing Address - Country:US
Mailing Address - Phone:708-448-3637
Mailing Address - Fax:708-448-4610
Practice Address - Street 1:12408 S HOBART ST
Practice Address - Street 2:
Practice Address - City:PALOS PARK
Practice Address - State:IL
Practice Address - Zip Code:60464-1754
Practice Address - Country:US
Practice Address - Phone:708-448-3637
Practice Address - Fax:708-448-4610
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.002258235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist