Provider Demographics
NPI:1851662928
Name:MINK, AMY S (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:S
Last Name:MINK
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1048 S KIMBLES RD
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-2634
Mailing Address - Country:US
Mailing Address - Phone:215-321-8973
Mailing Address - Fax:215-321-1301
Practice Address - Street 1:1048 S KIMBLES RD
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-2634
Practice Address - Country:US
Practice Address - Phone:215-321-8973
Practice Address - Fax:215-321-1301
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-22
Last Update Date:2012-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL004960L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist