Healthcare Provider Details

I. General information

NPI: 1023932795
Provider Name (Legal Business Name): AMY A. PEPITON
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 S 4TH AVE
SIDNEY OH
45365-9029
US

IV. Provider business mailing address

750 S 4TH AVE
SIDNEY OH
45365-9029
US

V. Phone/Fax

Practice location:
  • Phone: 937-497-2210
  • Fax:
Mailing address:
  • Phone: 937-497-2210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberLSP.01536
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: