Healthcare Provider Details

I. General information

NPI: 1992631741
Provider Name (Legal Business Name): AMY KATHLEEN IROZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1058 REDWOOD HWY FRONTAGE RD
MILL VALLEY CA
94941-1621
US

IV. Provider business mailing address

4696 BALSAM ST
SANTA ROSA CA
95404-9536
US

V. Phone/Fax

Practice location:
  • Phone: 415-924-2444
  • Fax:
Mailing address:
  • Phone: 707-529-3398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number21913
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: