Provider Demographics
NPI:1740521814
Name:TAXAY, AMY WYNNE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:WYNNE
Last Name:TAXAY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:WYNNE
Other - Last Name:FOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:42 MALLARD DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15238-1129
Mailing Address - Country:US
Mailing Address - Phone:412-767-5294
Mailing Address - Fax:
Practice Address - Street 1:9850 OLD PERRY HWY
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-9311
Practice Address - Country:US
Practice Address - Phone:412-847-7166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-13
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL003314L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist