Provider Demographics
NPI:1891970786
Name:SCHULTZ, AMY M (MS/CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:MS/CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 S CAROLINA LN
Mailing Address - Street 2:
Mailing Address - City:NEW FLORENCE
Mailing Address - State:PA
Mailing Address - Zip Code:15944-2442
Mailing Address - Country:US
Mailing Address - Phone:561-302-6745
Mailing Address - Fax:
Practice Address - Street 1:50 N MALIN RD
Practice Address - Street 2:
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-1429
Practice Address - Country:US
Practice Address - Phone:610-356-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL008324235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist