Healthcare Provider Details

I. General information

NPI: 1639175136
Provider Name (Legal Business Name): AMY LYNCH CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 WOOD ST
SISTERSVILLE WV
26175-1523
US

IV. Provider business mailing address

1523 4TH ST
MOUNDSVILLE WV
26041-1732
US

V. Phone/Fax

Practice location:
  • Phone: 304-652-1032
  • Fax:
Mailing address:
  • Phone: 304-845-5885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: