Amy Marie Gundlach, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

8722 Issued in MN

Practice address

15620 Edgewood Drive
Suite 240
Baxter, MN 56425

Phone

(218) 454-7012

Fax

(218) 454-7015

NPI assigned

Mar 13, 2012

Last updated

Mar 27, 2013By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Amy Marie Wegscheid Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Big Stone Therapies Baxter, LLC

  • Physical Therapy Clinic/Center
  • Baxter, MN
  • NPI 1194020669

  Speech-Language Pathologist

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1331596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1364342400000",
    "number": "1245505957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "309 WASHINGTON AVENUE",
            "city": "ORTONVILLE",
            "state": "MN",
            "postal_code": "56278",
            "telephone_number": "320-839-4271",
            "fax_number": "320-839-4196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15620 EDGEWOOD DRIVE",
            "address_2": "SUITE 240",
            "city": "BAXTER",
            "state": "MN",
            "postal_code": "56425",
            "telephone_number": "218-454-7012",
            "fax_number": "218-454-7015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUNDLACH",
        "first_name": "AMY",
        "middle_name": "MARIE",
        "credential": "CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-03-13",
        "last_updated": "2013-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MN",
            "license": "8722",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMY",
            "last_name": "WEGSCHEID",
            "middle_name": "MARIE",
            "credential": "CCC-SLP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Speech-Language Pathologist in Baxter, MN
• Providers in Baxter, MN by specialty
• Speech-Language Pathologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.