Provider Demographics
NPI:1396895470
Name:BUCK, AMY LOUISE (MS CCC- SLP)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LOUISE
Last Name:BUCK
Suffix:
Gender:F
Credentials:MS CCC- SLP
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:LOUISE
Other - Last Name:BAREKAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS SLP CF
Mailing Address - Street 1:17110 CARRINGTON PARK DR APT 801
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2634
Mailing Address - Country:US
Mailing Address - Phone:813-243-6076
Mailing Address - Fax:
Practice Address - Street 1:17110 CARRINGTON PARK DR APT 801
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-2634
Practice Address - Country:US
Practice Address - Phone:813-243-6076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ3746235Z00000X
FLSA9180235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL354957OtherWELLCARE
FL890741200Medicaid