Provider Demographics
NPI:1699082305
Name:TAVERNIER, AMY J (CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:AMY
Middle Name:J
Last Name:TAVERNIER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:J
Other - Last Name:TAVERNIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:10271 SCHUKNECHT RD
Mailing Address - Street 2:
Mailing Address - City:FILLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14735-8733
Mailing Address - Country:US
Mailing Address - Phone:585-610-3397
Mailing Address - Fax:
Practice Address - Street 1:46 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FRIENDSHIP
Practice Address - State:NY
Practice Address - Zip Code:14739-8701
Practice Address - Country:US
Practice Address - Phone:585-973-3311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-02
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012045235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist