Provider Demographics
NPI:1467864629
Name:PHILLIPS, AMY MICHELLE (MS)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:MICHELLE
Last Name:PHILLIPS
Suffix:
Gender:
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 E 39TH ST APT 127
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-1530
Mailing Address - Country:US
Mailing Address - Phone:785-324-1090
Mailing Address - Fax:
Practice Address - Street 1:888 HAINES STE 230
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-1008
Practice Address - Country:US
Practice Address - Phone:816-797-9690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-22
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020028775235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist