Provider Demographics
NPI:1609494038
Name:DOEZEMA, AMY GEYER (MS, CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:GEYER
Last Name:DOEZEMA
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 SPECKMAN RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-1876
Mailing Address - Country:US
Mailing Address - Phone:502-528-3741
Mailing Address - Fax:
Practice Address - Street 1:725 SPECKMAN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-1876
Practice Address - Country:US
Practice Address - Phone:502-528-3741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY101743231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist