Provider Demographics
NPI:1992729818
Name:NEUBECKER, AMY E (MS SLP-CCC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:E
Last Name:NEUBECKER
Suffix:
Gender:F
Credentials:MS SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 FAKES CT # 2433
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAM
Mailing Address - State:WI
Mailing Address - Zip Code:53916-2699
Mailing Address - Country:US
Mailing Address - Phone:920-392-5102
Mailing Address - Fax:
Practice Address - Street 1:104 FAKES CT
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-2699
Practice Address - Country:US
Practice Address - Phone:920-392-5122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI53-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI53-154OtherSPEECH