Provider Demographics
NPI:1588161079
Name:FISHER, AMY LETORT (SLP)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LETORT
Last Name:FISHER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7718 SOUTHERN BAY LN
Mailing Address - Street 2:
Mailing Address - City:VANCLEAVE
Mailing Address - State:MS
Mailing Address - Zip Code:39565-9692
Mailing Address - Country:US
Mailing Address - Phone:251-709-9218
Mailing Address - Fax:
Practice Address - Street 1:7718 SOUTHERN BAY LN
Practice Address - Street 2:
Practice Address - City:VANCLEAVE
Practice Address - State:MS
Practice Address - Zip Code:39565-9692
Practice Address - Country:US
Practice Address - Phone:251-709-9218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS3135235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist