Provider Demographics
NPI:1821246471
Name:ETKIE, AMY CHRISTINE (MS)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:CHRISTINE
Last Name:ETKIE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21929 CRICKLEWOOD TER
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-3053
Mailing Address - Country:US
Mailing Address - Phone:954-298-7591
Mailing Address - Fax:561-288-6000
Practice Address - Street 1:21929 CRICKLEWOOD TER
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-3053
Practice Address - Country:US
Practice Address - Phone:954-298-7591
Practice Address - Fax:561-288-6000
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2016-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 10046235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000394400Medicaid