Provider Demographics
NPI:1124269170
Name:ALLAMAN, AMY LYNN (MS)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:ALLAMAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 N PEBBLE CREEK PKWY
Mailing Address - Street 2:APT 2122
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-9000
Mailing Address - Country:US
Mailing Address - Phone:814-229-2566
Mailing Address - Fax:
Practice Address - Street 1:4200 N PEBBLE CREEK PKWY
Practice Address - Street 2:APT 2122
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-9000
Practice Address - Country:US
Practice Address - Phone:814-229-2566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP4727235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ276936Medicaid