Provider Demographics
NPI:1720316540
Name:D'ALFONSO, AMY CARRUBBA (SLP)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:CARRUBBA
Last Name:D'ALFONSO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 SAINT JAMES DR
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-1660
Mailing Address - Country:US
Mailing Address - Phone:504-468-9482
Mailing Address - Fax:
Practice Address - Street 1:4101 SAINT JAMES DR
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-1660
Practice Address - Country:US
Practice Address - Phone:504-468-9482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-07
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6205235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist