MEDICARE: MRS. AMY LYNN O'LAUGHLIN MA, 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	3798-154	WI
2	235Z00000X	Speech-Language Pathologist	8502	MN

General Provider Information

NPI Number	:	1922434323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMY LYNN O'LAUGHLIN MA, CCC-SLP

Provider Business Mailing Address
First Line	:	1347 W BROADWAY ST
Second Line	:
City	:	WINONA
State	:	MN
Zip	:	55987-2327
Country	:	US
Telephone Number	:	507-205-6201
Fax Number	:

Provider Business Practice Location Address
First Line	:	1347 W BROADWAY ST
Second Line	:
City	:	WINONA
State	:	MN
Zip	:	55987-2327
Country	:	US
Telephone Number	:	507-205-6201
Fax Number	:

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

Provider Enumeration Date	:	09/18/2013
Last Update Date	:	09/27/2018

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