Provider Demographics
NPI:1679054084
Name:KRIEGER, AMY RAE (MS, CCC/SLP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:RAE
Last Name:KRIEGER
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:RAE
Other - Last Name:LUTHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC/SLP
Mailing Address - Street 1:PO BOX 81
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:PA
Mailing Address - Zip Code:19470-0081
Mailing Address - Country:US
Mailing Address - Phone:904-923-0440
Mailing Address - Fax:
Practice Address - Street 1:3300 SAINT PETERS RD
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:PA
Practice Address - Zip Code:19470-9901
Practice Address - Country:US
Practice Address - Phone:904-923-0440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL003176L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA9394634Medicaid