Provider Demographics
NPI:1356481766
Name:SCHINK, POLLY L (MS CCC SLP)
Entity type:Individual
Prefix:MS
First Name:POLLY
Middle Name:L
Last Name:SCHINK
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 QUINCY STREET
Mailing Address - Street 2:
Mailing Address - City:STURGEON BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54235
Mailing Address - Country:US
Mailing Address - Phone:920-495-3751
Mailing Address - Fax:920-592-9320
Practice Address - Street 1:926 WILLARD DR
Practice Address - Street 2:SUITE 114
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304
Practice Address - Country:US
Practice Address - Phone:920-592-9330
Practice Address - Fax:920-592-9320
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2213154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42789600Medicaid