Provider Demographics
NPI:1982984928
Name:COLE, AMY JANE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:JANE
Last Name:COLE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:JANE
Other - Last Name:RUNDELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:3136 NW 72ND AVE
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-7860
Mailing Address - Country:US
Mailing Address - Phone:954-559-9254
Mailing Address - Fax:
Practice Address - Street 1:3136 NW 72ND AVE
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-7860
Practice Address - Country:US
Practice Address - Phone:954-559-9254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-22
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA11666235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist