Provider Demographics
NPI:1558494021
Name:SCHLEGEL, AMY LOUISE (LAC, DAOM)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:LOUISE
Last Name:SCHLEGEL
Suffix:
Gender:F
Credentials:LAC, DAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1153 MCKINLEY AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-3950
Mailing Address - Country:US
Mailing Address - Phone:415-690-3934
Mailing Address - Fax:907-313-1400
Practice Address - Street 1:3654 GRAND AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-2008
Practice Address - Country:US
Practice Address - Phone:415-690-3934
Practice Address - Fax:907-313-1400
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC8828171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA202851611OtherTAX ID