Basic Information
| Provider Information | |||||||||
| NPI: | 1770921389 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VITALE | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | CHRISTINE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MA CCC SLP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CIARAMITARO | ||||||||
| OtherFirstName: | AMY | ||||||||
| OtherMiddleName: | CHRISTINE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MA CCC SLP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 14145 SIMONE DR. | ||||||||
| Address2: | DEVELOPING CONNECTIONS INC | ||||||||
| City: | SHELBY TWP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5865666280 | ||||||||
| FaxNumber: | 5865661898 | ||||||||
| Practice Location | |||||||||
| Address1: | 14145 SIMONE DR. | ||||||||
| Address2: | DEVELOPING CONNECTIONS INC | ||||||||
| City: | SHELBY TWP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5865666280 | ||||||||
| FaxNumber: | 5865661898 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2013 | ||||||||
| LastUpdateDate: | 12/15/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 14045928 | MI | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.