Provider Demographics
NPI:1205262961
Name:SCHULTING, AMY B (PHD, MED, LP)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:B
Last Name:SCHULTING
Suffix:
Gender:F
Credentials:PHD, MED, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11900 WAYZATA BLVD STE 132
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-2018
Mailing Address - Country:US
Mailing Address - Phone:952-236-6193
Mailing Address - Fax:320-396-1934
Practice Address - Street 1:11900 WAYZATA BLVD STE 132
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-2018
Practice Address - Country:US
Practice Address - Phone:952-236-6193
Practice Address - Fax:320-396-1934
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-25
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5642103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNLP5642OtherMINNESOTA BOARD OF PSYCHOLOGY