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General NPI Number Information
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NPI Number | 1578513487
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Entity Type | Individual
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Provider Name | AMY LYN HUMBERT
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Gender | Female
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 12409 W INDIAN SCHOOL RD SUITE C306
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City | AVONDALE
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State | AZ
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Zip | 85323-9502
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Country | US
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Telephone | 623-935-6040
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Fax |
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Provider Business Mailing Address
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Address Line | 10850 W ROANOKE AVE
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City | AVONDALE
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State | AZ
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Zip | 85323-5811
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Country | US
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Telephone | 623-826-1840
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Fax |
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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 | TSLP4840
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License Number State | AZ
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