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General NPI Number Information
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NPI Number | 1568617181
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Entity Type | Individual
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Provider Name | AMY E DOUGHERTY CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 11/24/2008
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Last Update Date | 11/24/2008
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Provider Practice Location Address
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Address Line | 2568 ALGONKIN TRL
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City | MANASQUAN
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State | NJ
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Zip | 08736-2330
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Country | US
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Telephone | 732-722-7570
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Fax |
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Provider Business Mailing Address
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Address Line | 2435 HIGHWAY 34 # 118B
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City | MANASQUAN
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State | NJ
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Zip | 08736-1819
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Country | US
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Telephone | 732-722-7570
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Fax | 732-612-1046
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | YS02924
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License Number State | NJ
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