Provider Demographics
NPI:1316712607
Name:BLUMSTEIN, AMY LEIGH (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LEIGH
Last Name:BLUMSTEIN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 N MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:VILLA PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60181-2226
Mailing Address - Country:US
Mailing Address - Phone:708-738-3995
Mailing Address - Fax:
Practice Address - Street 1:340 S SCHOOL ST
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-3070
Practice Address - Country:US
Practice Address - Phone:630-516-7861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.014941235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist