Basic Information
| Provider Information | |||||||||
| NPI: | 1861634164 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BARRETT | ||||||||
| FirstName: | AMY | ||||||||
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| Credential: | M.S., CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11702 SW 81ST RD | ||||||||
| Address2: | |||||||||
| City: | PINECREST | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331564418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3058121123 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11440 N KENDALL DR | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331761044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3059298705 | ||||||||
| FaxNumber: | 3056003713 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2009 | ||||||||
| LastUpdateDate: | 11/04/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SA 6246 | FL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 890310700 | 05 | FL | MEDICAID |