Provider Demographics
NPI:1841604477
Name:NALLY, AMY (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:NALLY
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1578 LAKELAND AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-3817
Mailing Address - Country:US
Mailing Address - Phone:440-336-4716
Mailing Address - Fax:
Practice Address - Street 1:33355 HEALTH CAMPUS BLVD
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-1399
Practice Address - Country:US
Practice Address - Phone:440-937-9099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-11
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOND. 2014288-SP235Z00000X
OHSP.11583235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist