Provider Demographics
NPI:1104480110
Name:BABCOCK, AMELIA ELIZABETH
Entity type:Individual
Prefix:MS
First Name:AMELIA
Middle Name:ELIZABETH
Last Name:BABCOCK
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 1:355 HARLEM RD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-1892
Mailing Address - Country:US
Mailing Address - Phone:716-821-7000
Mailing Address - Fax:716-821-7139
Practice Address - Street 1:355 HARLEM RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-1825
Practice Address - Country:US
Practice Address - Phone:716-821-7000
Practice Address - Fax:716-821-7139
Is Sole Proprietor?:No
Enumeration Date:2019-04-24
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY029681235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program