Provider Demographics
NPI:1083904395
Name:SCHULTZ, LOUISE MARIE (CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:LOUISE
Middle Name:MARIE
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 W. NEWELL ST. ROOM 221
Mailing Address - Street 2:MCKINLEY BRIGHTON SCHOOL
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13205
Mailing Address - Country:US
Mailing Address - Phone:315-435-4210
Mailing Address - Fax:315-435-4553
Practice Address - Street 1:335 MONTGOMERY ST
Practice Address - Street 2:CARNEGIE SCHOOL ROOM 200
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-2009
Practice Address - Country:US
Practice Address - Phone:315-435-4210
Practice Address - Fax:315-435-4553
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-08
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY57 001717-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist