Provider Demographics
NPI:1104499300
Name:HOLZUM, AMY SUZANNE (MA CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:SUZANNE
Last Name:HOLZUM
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:SUZANNE
Other - Last Name:TINDALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10913 FLOWER MOUND PL
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-7109
Mailing Address - Country:US
Mailing Address - Phone:317-410-8669
Mailing Address - Fax:
Practice Address - Street 1:118 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3323
Practice Address - Country:US
Practice Address - Phone:317-844-4211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004302A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist