Provider Demographics
NPI:1023282175
Name:BREISCH, AMY M (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:BREISCH
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:M
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4646 N 800 E
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901-8440
Mailing Address - Country:US
Mailing Address - Phone:765-860-1684
Mailing Address - Fax:
Practice Address - Street 1:4646 N 800 E
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-8440
Practice Address - Country:US
Practice Address - Phone:765-860-1684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-19
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004430A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist