Provider Demographics
NPI:1255460903
Name:SIEGENTHALER, AMY BROCK (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:BROCK
Last Name:SIEGENTHALER
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 RHYTHM ST
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29486-5443
Mailing Address - Country:US
Mailing Address - Phone:843-819-2948
Mailing Address - Fax:843-793-3777
Practice Address - Street 1:505 RHYTHM ST
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29486-5443
Practice Address - Country:US
Practice Address - Phone:843-819-2948
Practice Address - Fax:843-793-3777
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3539235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSA0534Medicaid