Provider Demographics
NPI:1821648163
Name:KOHLMORGEN, AMY CHRISTINE
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:CHRISTINE
Last Name:KOHLMORGEN
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 1:653 DEGRAW ST APT 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-3111
Mailing Address - Country:US
Mailing Address - Phone:765-618-4759
Mailing Address - Fax:
Practice Address - Street 1:1401 AVENUE I
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-3003
Practice Address - Country:US
Practice Address - Phone:718-377-7507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029114235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist