Provider Demographics
NPI:1821184755
Name:SKIVER, AMY B (MA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:B
Last Name:SKIVER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 GEORGE ST STE 108
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-2773
Mailing Address - Country:US
Mailing Address - Phone:920-645-2810
Mailing Address - Fax:
Practice Address - Street 1:416 GEORGE ST STE 108
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-2773
Practice Address - Country:US
Practice Address - Phone:920-645-2810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI375112S101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41002000Medicaid