Provider Demographics
NPI:1265723738
Name:MARTELLE, AMY (CCC-SLP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:MARTELLE
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 21
Mailing Address - Street 2:
Mailing Address - City:HAGAMAN
Mailing Address - State:NY
Mailing Address - Zip Code:12086
Mailing Address - Country:US
Mailing Address - Phone:518-842-0436
Mailing Address - Fax:
Practice Address - Street 1:11 LIBERTY STREET
Practice Address - Street 2:GREATER AMSTERDAM SCHOOL DISTRICT
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010
Practice Address - Country:US
Practice Address - Phone:518-843-3180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-02
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015544235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist