Provider Demographics
NPI:1255753752
Name:DUMOCH, AMY
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:DUMOCH
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 1:125 HOOP POLE HILL RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06798-1926
Mailing Address - Country:US
Mailing Address - Phone:203-263-2206
Mailing Address - Fax:203-263-2709
Practice Address - Street 1:125 HOOP POLE HILL RD
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:CT
Practice Address - Zip Code:06798-1926
Practice Address - Country:US
Practice Address - Phone:203-263-2709
Practice Address - Fax:203-263-2709
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-17
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001010235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist