Provider Demographics
NPI:1639725062
Name:SCHAAFSMA, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:SCHAAFSMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:567 V W AVE E
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49097
Mailing Address - Country:US
Mailing Address - Phone:269-501-4938
Mailing Address - Fax:
Practice Address - Street 1:567 V W AVE E
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MI
Practice Address - Zip Code:49097-4909
Practice Address - Country:US
Practice Address - Phone:269-501-4938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801105280104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker