Provider Demographics
NPI:1588895452
Name:GRISWOLD, AMY MARIE (SLP)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:MARIE
Last Name:GRISWOLD
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 1:598 LUTZVILLE RD
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:PA
Mailing Address - Zip Code:15537-6703
Mailing Address - Country:US
Mailing Address - Phone:724-681-2062
Mailing Address - Fax:
Practice Address - Street 1:3053 NEW GERMANY RD
Practice Address - Street 2:
Practice Address - City:EBENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15931-3516
Practice Address - Country:US
Practice Address - Phone:814-472-1100
Practice Address - Fax:814-472-1105
Is Sole Proprietor?:No
Enumeration Date:2009-07-27
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL009198235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA163521R9XMedicare Oscar/Certification