Provider Demographics
NPI:1295967503
Name:OW, AMY RENEE (MS CCC/SLP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:RENEE
Last Name:OW
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:RENEE
Other - Last Name:BELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC/SLP
Mailing Address - Street 1:2222 SULLIVAN TRL
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18040-7958
Mailing Address - Country:US
Mailing Address - Phone:800-944-9782
Mailing Address - Fax:610-438-2024
Practice Address - Street 1:9070 SW 80TH AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34481-8905
Practice Address - Country:US
Practice Address - Phone:352-861-4444
Practice Address - Fax:352-861-4445
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8542235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist