Provider Demographics
NPI:1821412875
Name:SCHULTZ, KATJA (SLP)
Entity Type:Individual
Prefix:
First Name:KATJA
Middle Name:
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 BARTON ST
Mailing Address - Street 2:
Mailing Address - City:MILLERTON
Mailing Address - State:NY
Mailing Address - Zip Code:12546-5261
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16 BARTON ST
Practice Address - Street 2:
Practice Address - City:MILLERTON
Practice Address - State:NY
Practice Address - Zip Code:12546-5261
Practice Address - Country:US
Practice Address - Phone:301-655-8136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-11
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022442-1235Z00000X
CT004763235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist