Provider Demographics
NPI:1306005228
Name:AUSTIN, AMY ELIZABETH (MS CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:ELIZABETH
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:ELIZABETH
Other - Last Name:PUTNAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:217 YARMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:ME
Mailing Address - Zip Code:04039-9512
Mailing Address - Country:US
Mailing Address - Phone:603-345-2283
Mailing Address - Fax:
Practice Address - Street 1:217 YARMOUTH RD
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:ME
Practice Address - Zip Code:04039-9512
Practice Address - Country:US
Practice Address - Phone:033-452-2836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP1867235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432670399Medicaid