Provider Demographics
NPI:1366435240
Name:SUHUMSKIE, AMY ALLISON (MA-CCC-A)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:ALLISON
Last Name:SUHUMSKIE
Suffix:
Gender:F
Credentials:MA-CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 SUMMER LEE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032
Mailing Address - Country:US
Mailing Address - Phone:972-771-5443
Mailing Address - Fax:972-771-5444
Practice Address - Street 1:1320 SUMMER LEE DR
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032
Practice Address - Country:US
Practice Address - Phone:972-771-5443
Practice Address - Fax:972-771-5444
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80079231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR900847004OtherBLUE CROSS BLUE SHIELD
TXTXB142013OtherINDIVIDUAL PTAN
OR069067Medicaid
ORP00223552OtherRAIL ROAD MEDICARE
OR900847004OtherBLUE CROSS BLUE SHIELD