Provider Demographics
NPI:1780495648
Name:MUTINELLI, AMELIA LOUISE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:LOUISE
Last Name:MUTINELLI
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 CONNEAUT LAKE RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16125-9406
Mailing Address - Country:US
Mailing Address - Phone:412-841-1191
Mailing Address - Fax:
Practice Address - Street 1:120 S BROAD ST STE A
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:PA
Practice Address - Zip Code:16127-1544
Practice Address - Country:US
Practice Address - Phone:724-752-1551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-18
Last Update Date:2025-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL018168235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist