Provider Demographics
NPI:1710178603
Name:WINN, AMY J (MAED, IECE)
Entity Type:Individual
Prefix:MISS
First Name:AMY
Middle Name:J
Last Name:WINN
Suffix:
Gender:F
Credentials:MAED, IECE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1351 NEWTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-1217
Mailing Address - Country:US
Mailing Address - Phone:859-253-1686
Mailing Address - Fax:859-254-2743
Practice Address - Street 1:343 WALLER AVE
Practice Address - Street 2:STE 201
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-2912
Practice Address - Country:US
Practice Address - Phone:859-271-9448
Practice Address - Fax:859-272-6893
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
KY201133920222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30615058Medicaid