Individual
AMY LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
3900 CHURCH RD, MOUNT LAUREL, NJ 08054-1108
(800) 774-5516
(856) 429-4755
Mailing address
1255 CALDWELL RD, CHERRY HILL, NJ 08034-3220
(800) 774-5516
(856) 429-4755
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
41YS00861600
NJ
235Z00000X
Speech-Language Pathologist
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—
Other
Enumeration date
07/30/2018
Last updated
07/30/2018
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