Healthcare Provider Details

I. General information

NPI: 1104901966
Provider Name (Legal Business Name): ALISON RENEE AMSHOFF SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALISON RENEE GUMM SLP

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3704 NORBOURNE BLVD.
LOUISVILLE KY
40207
US

IV. Provider business mailing address

3704 NORBOURNE BLVD.
LOUISVILLE KY
40207
US

V. Phone/Fax

Practice location:
  • Phone: 502-645-0121
  • Fax: 502-873-4211
Mailing address:
  • Phone: 502-645-0121
  • Fax: 502-873-4211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225CA2400X
TaxonomyAssistive Technology Practitioner Rehabilitation Counselor
License Number5275RESNA
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberKY-2900
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number140663
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: