Provider Demographics
NPI:1699912568
Name:STODDARD, AMY LYNN (MS)
Entity type:Individual
Prefix:MISS
First Name:AMY
Middle Name:LYNN
Last Name:STODDARD
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N WHISMAN RD APT 2013
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94043-4926
Mailing Address - Country:US
Mailing Address - Phone:408-655-4732
Mailing Address - Fax:
Practice Address - Street 1:100 N WHISMAN RD APT 2013
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94043-4926
Practice Address - Country:US
Practice Address - Phone:408-655-4732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17306235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA17306OtherSPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY BOARD