Provider Demographics
NPI:1922047117
Name:STREETER, AMY BETH (MSCCCSLP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:BETH
Last Name:STREETER
Suffix:
Gender:F
Credentials:MSCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10766 N MEQUON TRL
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-8550
Mailing Address - Country:US
Mailing Address - Phone:262-242-7737
Mailing Address - Fax:
Practice Address - Street 1:10766 N MEQUON TRL
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-8550
Practice Address - Country:US
Practice Address - Phone:262-242-7737
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1010154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist