Provider Demographics
NPI:1831763747
Name:AMY'S SPEECH SHOP L.L.C
Entity type:Organization
Organization Name:AMY'S SPEECH SHOP L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:AMY-MARETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:907-350-5363
Mailing Address - Street 1:1616 HARDWOOD CT
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-1970
Mailing Address - Country:US
Mailing Address - Phone:907-350-5363
Mailing Address - Fax:
Practice Address - Street 1:1616 HARDWOOD CT
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-1970
Practice Address - Country:US
Practice Address - Phone:907-350-5363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-14
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech