Healthcare Provider Details

I. General information

NPI: 1811065063
Provider Name (Legal Business Name): AMY BEUKEMA M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMY RIBBLETT M.S., CCC-SLP

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 08/19/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 BRENNEN DR
NEWARK DE
19713-3906
US

IV. Provider business mailing address

519 WAKE FOREST DR
NEWARK DE
19713-1197
US

V. Phone/Fax

Practice location:
  • Phone: 302-454-2202
  • Fax:
Mailing address:
  • Phone: 302-419-8152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number01-0000846
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: