Provider Demographics
NPI:1609920446
Name:BOSS, AMY JEAN (MA CCC SLP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:JEAN
Last Name:BOSS
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 1:1128 WHITE ROCK DR
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:IL
Mailing Address - Zip Code:61021-9049
Mailing Address - Country:US
Mailing Address - Phone:815-652-5257
Mailing Address - Fax:
Practice Address - Street 1:1128 WHITE ROCK DR
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:IL
Practice Address - Zip Code:61021-9049
Practice Address - Country:US
Practice Address - Phone:815-652-5257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.006570235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist