Active NPI
Amy Marie Coburn, MA-SLP
- Speech-Language Pathologist
- Watertown, NY
National Provider Identifier
1295988368
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 014471-1
- Practice address
- 110 Bishop St
Watertown, NY 13601-4604 - Phone
- (315) 486-7641
- NPI assigned
- Nov 2, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 014471-1 | NY | Primary |
Addresses
Primary practice location
110 Bishop St
Watertown, NY 13601-4604
Mailing address
110 Bishop St
Watertown, NY 13601-4604
Phone (315) 486-7641
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 014471-1 | NY | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1225584000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1340064000000",
"number": "1295988368",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "110 BISHOP ST",
"city": "WATERTOWN",
"state": "NY",
"postal_code": "136014604",
"telephone_number": "315-486-7641"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 BISHOP ST",
"city": "WATERTOWN",
"state": "NY",
"postal_code": "136014604",
"telephone_number": "315-486-7641"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COBURN",
"first_name": "AMY",
"middle_name": "MARIE",
"name_prefix": "Mrs.",
"credential": "MA-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-11-02",
"last_updated": "2012-06-19",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NY",
"license": "014471-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Watertown, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.