Provider Demographics
NPI:1609093517
Name:LIPPINCOTT, AMY MICHELE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:MICHELE
Last Name:LIPPINCOTT
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MRS
Other - First Name:AMY
Other - Middle Name:MICHELE
Other - Last Name:NEWMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:6307 LONGLEAF PINE CT
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-2813
Mailing Address - Country:US
Mailing Address - Phone:618-713-0923
Mailing Address - Fax:
Practice Address - Street 1:6307 LONGLEAF PINE CT
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202
Practice Address - Country:US
Practice Address - Phone:618-713-0923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.008595235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6186848232OtherINSURANCE