Provider Demographics
NPI:1063762748
Name:CONDINO, AMY SUE
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:SUE
Last Name:CONDINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7361 PRAIRIE FALCON RD
Mailing Address - Street 2:STE 130
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0823
Mailing Address - Country:US
Mailing Address - Phone:702-804-1511
Mailing Address - Fax:702-804-2551
Practice Address - Street 1:7361 PRAIRIE FALCON RD
Practice Address - Street 2:STE 130
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0823
Practice Address - Country:US
Practice Address - Phone:702-804-1511
Practice Address - Fax:702-804-2551
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-11
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1441235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist