Healthcare Provider Details

I. General information

NPI: 1821280439
Provider Name (Legal Business Name): AMY LYNN BEREITER M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2007
Last Update Date: 08/19/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROCHESTER SCHOOL DEPARTMENT 150 WAKEFIELD ST, SUITE #8
ROCHESTER NH
03867
US

IV. Provider business mailing address

204 1/2 ADAMS AVE
ALEXANDRIA VA
22301-2110
US

V. Phone/Fax

Practice location:
  • Phone: 603-332-3678
  • Fax:
Mailing address:
  • Phone: 224-433-0281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146008132
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2260
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: