Provider Demographics
NPI:1184139917
Name:ANTINORO, AMY LURETHA (MS,CCC-SLP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LURETHA
Last Name:ANTINORO
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 1:7016 CHATFORD CT
Mailing Address - Street 2:
Mailing Address - City:CASTLE PINES
Mailing Address - State:CO
Mailing Address - Zip Code:80108-3466
Mailing Address - Country:US
Mailing Address - Phone:303-358-3121
Mailing Address - Fax:
Practice Address - Street 1:7016 CHATFORD CT
Practice Address - Street 2:
Practice Address - City:CASTLE PINES
Practice Address - State:CO
Practice Address - Zip Code:80108-3466
Practice Address - Country:US
Practice Address - Phone:303-358-3121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-01
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0001362235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist