Provider Demographics
NPI:1598902850
Name:MICHALAK, AMY M (MACCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:M
Last Name:MICHALAK
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-4947
Mailing Address - Country:US
Mailing Address - Phone:315-457-9307
Mailing Address - Fax:315-457-9307
Practice Address - Street 1:210 3RD ST
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-4947
Practice Address - Country:US
Practice Address - Phone:315-457-9307
Practice Address - Fax:315-457-9307
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012148235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist