| Doctor Name: | MS. AMY VALENTINE TIDIK |
| NPI Number: | 1043526056 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA,CCC-SP |
| License Number: | 15475 |
| Business Practice Address: | 1130 Grove St San Luis Obispo, CA - 934012914 |
| Business Phone Number: | 8055433945 |
| Business Fax Number: | |
| Mailing Address: | 5875 Salisbury Ln, SAN LUIS OBISPO |
| State: | CA |
| Postal Code: | 934018267 |
| Phone Number: | 8054595775 |
| Fax Number: | 8055433121 |
| NPI Enumeration Date: | 08/27/2010 |
| NPI Last Update Date: | 08/27/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 15475 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |