Provider Demographics
NPI:1104250695
Name:BAUSCHLICHER, AMY ELIZABETH (SLP-CCC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:ELIZABETH
Last Name:BAUSCHLICHER
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4450 W EAU GALLIE BLVD STE 180
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32934-7277
Mailing Address - Country:US
Mailing Address - Phone:321-255-6627
Mailing Address - Fax:
Practice Address - Street 1:4450 W EAU GALLIE BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32934-7213
Practice Address - Country:US
Practice Address - Phone:321-255-6627
Practice Address - Fax:321-253-9777
Is Sole Proprietor?:No
Enumeration Date:2013-09-03
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ 6355235Z00000X
FL13465235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist