Provider Demographics
NPI:1427530575
Name:BACKSTROM, AMY L (MS, MAS)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:BACKSTROM
Suffix:
Gender:F
Credentials:MS, MAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 HIGHLAND AVE STE 202A
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-2547
Mailing Address - Country:US
Mailing Address - Phone:203-806-5221
Mailing Address - Fax:
Practice Address - Street 1:315 HIGHLAND AVE STE 202A
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-2547
Practice Address - Country:US
Practice Address - Phone:203-860-5221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach