Provider Demographics
NPI:1124243639
Name:ZMISTOWSKI, AMY M (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:M
Last Name:ZMISTOWSKI
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 S FLAMINGO RD # 329
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-1770
Mailing Address - Country:US
Mailing Address - Phone:786-525-9088
Mailing Address - Fax:954-322-1207
Practice Address - Street 1:12112 SAINT ANDREWS PL APT 206
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-0705
Practice Address - Country:US
Practice Address - Phone:786-525-9088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA5839235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL887038100Medicaid