Provider Demographics
NPI:1992291058
Name:TODD, AMY LEEANN (CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:AMY
Middle Name:LEEANN
Last Name:TODD
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 681
Mailing Address - Street 2:
Mailing Address - City:WALLINS CREEK
Mailing Address - State:KY
Mailing Address - Zip Code:40873-0681
Mailing Address - Country:US
Mailing Address - Phone:606-273-3014
Mailing Address - Fax:
Practice Address - Street 1:200 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:HARLAN
Practice Address - State:KY
Practice Address - Zip Code:40831-0014
Practice Address - Country:US
Practice Address - Phone:606-573-7261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist