Healthcare Provider Details

I. General information

NPI: 1427439397
Provider Name (Legal Business Name): AMY BUZZELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2015
Last Update Date: 06/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3040 KEMP RD
BEAVERCREEK OH
45431-2644
US

IV. Provider business mailing address

3040 KEMP RD
BEAVERCREEK OH
45431-2644
US

V. Phone/Fax

Practice location:
  • Phone: 937-458-2425
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberOH1192464
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: