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General NPI Number Information
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NPI Number | 1497999361
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Entity Type | Organization
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Legal Business Name | AMY MICKLICH SPEECH LANGUAGE PATHOLOGY SERVICES
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Dates
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Enumeration Date | 04/23/2009
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Last Update Date | 04/23/2009
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Provider Practice Location Address
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Address Line | 293 SPRING ST.
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City | ROCKVILLE
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State | RI
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Zip | 02873-0069
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Country | US
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Telephone | 401-578-8348
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Fax | 401-539-2319
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Provider Business Mailing Address
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Address Line | 293 SPRING ST. P.O. BOX 69
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City | ROCKVILLE
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State | RI
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Zip | 02873-0069
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Country | US
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Telephone | 401-578-8348
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Fax | 401-539-2319
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Authorized Official
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Title or Position | OWNER
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Name | MS. AMY L. MICKLICH
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Credential |
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Telephone | 401-578-8348
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP00578
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License Number State | RI
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