Independent US Healthcare Provider Directory & Public Medical Database
Deactivated NPI 1184749806 Deactivated / Inactive NPI Female Practitioner

Amy Lloyd Lysen , MS, CCC-SLP

Speech-Language Pathologist • Smithfield, NC

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Amy Lysen has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date March 20, 2007
NPI Deactivation Date January 19, 2023
Total Practice Duration ~16 Years of Practice (2007 – 2023)

Professional Overview & Biography Verified Profile Summary

Amy Lysen, MS, CCC-SLP was a registered Speech-Language Pathologist practicing in Smithfield, NC. Throughout an active medical career spanning 16 years, Amy Lysen provided care at the practice location at 447 VENTURE DR STE D until profile deactivation on 2023-01-19.

Practice Location & Contact Primary Location

Practice Address

447 Venture Dr Ste D

Smithfield, NC 275774765

Telephone 9102982331
Associated Practice Facility / Clinic
🏢 Advantage Ot Inc. Facility NPI 1962717025

Specialty Benchmarks & Practice Insights

Comparative analytics for Speech-Language Pathologist in Smithfield, NC

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 5.3 Yrs
State Avg: 15.0 Yrs
Regional Practice Density
111 Specialists

Practicing in Smithfield, NC (7242 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2023-02-20
Speech-Language Pathologist Primary Specialty

NUCC Taxonomy Code: 235Z00000X

State License NC 4619

The speech-language pathologist is the professional who engages in clinical services, prevention, advocacy, education, administration, and research in the areas of communication and swallowing across the life span from infancy through geriatrics. Speech-language pathologists address typical and atypical impairments and disorders related to communication and swallowing in the areas of speech sound production, resonance, voice, fluency, language (comprehension and expression), cognition, and feeding and swallowing.

Additional State Medicaid & Healthcare Payer Identifiers

Commercial Insurance / Payer ID Bcbs
135J7 (NC)

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

40 Associated Practitioners
Andrea Emerick

Occupational Therapist

NPI 1023574126
Linda Martin , OTR, L

Occupational Therapist

NPI 1033449293

Occupational Therapist Registered, L

Dr. Allie Miller , OTD, OTR, L

Occupational Therapist

NPI 1063148930

Doctor of Occupational Therapy, Occupational Therapist Registered, L

Abigail Carter , OT

Occupational Therapist

NPI 1093487761

Occupational Therapist

Briyana Jackson , OTR, L

Occupational Therapist

NPI 1124757463

Occupational Therapist Registered, L

Kaitlyn Groft

Speech-Language Pathologist

NPI 1124815121

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

11 Historical Events
📍
Updated Practice Location February 20, 2023

Registered at 447 VENTURE DR STE D, SMITHFIELD, NC 275774765 (Tel: 9102982331)

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Updated Business Mailing Address February 20, 2023

Registered at 210 E HORNE ST, CLAYTON, NC 275202444 (Tel: 9196140628)

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Provider Name / Credentials Updated February 20, 2023

Recorded as AMY LYSEN, M.S., CCC-SLP

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NPI Profile Reactivated February 07, 2023

Record officially reactivated for active practice on February 07, 2023

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NPI Profile Deactivated January 19, 2023

Record deactivated on January 19, 2023

NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

📍
Updated Practice Location July 08, 2007

Registered at 319 CHAPANOKE RD, SUITE 101, RALEIGH, NC 276033433 (Tel: 9196624600)

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Updated Business Mailing Address July 08, 2007

Registered at 1005 HIGHLANDER DR, RALEIGH, NC 276038573 (Tel: 9197738554)

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Provider Name / Credentials Updated July 08, 2007

Recorded as AMY GINGERY, M.S., CCC-SLP

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Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Speech-Language Pathologist (License #4619 in NC)

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Initial NPI Registration & Enumeration March 20, 2007

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1184749806
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: March 20, 2007
Last Update: February 20, 2023
Deactivation Date: January 19, 2023
Sole Proprietor: No

Mailing Address

210 E Horne St

Clayton, NC 275202444

Phone: 9196140628

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.