Healthcare Provider Details

I. General information

NPI: 1801516927
Provider Name (Legal Business Name): AMY KATHLYN KARLBERG MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 08/30/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 SAYBROOK RD LOWR LEVEL
MIDDLETOWN CT
06457-4788
US

IV. Provider business mailing address

305 S MAIN ST APT A07
MIDDLETOWN CT
06457-4210
US

V. Phone/Fax

Practice location:
  • Phone: 860-358-2700
  • Fax:
Mailing address:
  • Phone: 860-333-4342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number006718
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: