Provider Demographics
NPI:1710196514
Name:AMY, SANDRA L (MA)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:L
Last Name:AMY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31890 S GALENA DR
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85653-8868
Mailing Address - Country:US
Mailing Address - Phone:520-419-6419
Mailing Address - Fax:
Practice Address - Street 1:31890 S GALENA DR
Practice Address - Street 2:
Practice Address - City:MARANA
Practice Address - State:AZ
Practice Address - Zip Code:85653-8868
Practice Address - Country:US
Practice Address - Phone:520-419-6419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0037235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist