MEDICARE: MRS. AMY MATHENY CHURILLA M.S. CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	18323	MD

General Provider Information

NPI Number	:	1740401579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMY MATHENY CHURILLA M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	4962 REEDY BROOK LN
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21044-1514
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7300 GOLDEN FERN COURT
Second Line	:
City	:	ELKRIDGE
State	:	MD
Zip	:	21044
Country	:	US
Telephone Number	:	410-796-8499
Fax Number	:	443-270-8260

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	07/08/2007

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