Provider Demographics
NPI:1720599954
Name:MUZYNOSKI, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:MUZYNOSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 GRACERN RD STE 450
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-7657
Mailing Address - Country:US
Mailing Address - Phone:803-227-3757
Mailing Address - Fax:
Practice Address - Street 1:720 GRACERN RD STE 450
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-7657
Practice Address - Country:US
Practice Address - Phone:803-227-3757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-16
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6130235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist