Provider Demographics
NPI:1104256072
Name:BLEIWEISS, AMY X (SPEECH LANGUAGE PATH)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:
Last Name:BLEIWEISS
Suffix:X
Gender:F
Credentials:SPEECH LANGUAGE PATH
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:BLEIWEISS
Other - Suffix:X
Other - Last Name Type:Professional Name
Other - Credentials:MACCCSLP
Mailing Address - Street 1:53 CLARK AVE
Mailing Address - Street 2:UNIT 2
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-4061
Mailing Address - Country:US
Mailing Address - Phone:413-582-1811
Mailing Address - Fax:
Practice Address - Street 1:53 CLARK AVE
Practice Address - Street 2:UNIT 2
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-4061
Practice Address - Country:US
Practice Address - Phone:413-582-1811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4177235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist