Provider Demographics
NPI:1790086304
Name:DANNENFELDT, AMY L (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:L
Last Name:DANNENFELDT
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 1:2555 BERKSHIRE PKWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-4646
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2555 BERKSHIRE PKWY
Practice Address - Street 2:SUITE B
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-4646
Practice Address - Country:US
Practice Address - Phone:515-987-8835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01521235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist