Provider Demographics
NPI:1821319237
Name:LIBBY, AMY MARIE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:LIBBY
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 FARMWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-6926
Mailing Address - Country:US
Mailing Address - Phone:603-498-8544
Mailing Address - Fax:
Practice Address - Street 1:40 SEWALLS FALLS RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-4649
Practice Address - Country:US
Practice Address - Phone:603-225-0853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-21
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHP-0450235Z00000X
NH1346235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1346OtherLICENSE