Provider Demographics
NPI:1952345860
Name:SCHWARTZ, AMY L (LMP,LAC)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:L
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:LMP,LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1362
Mailing Address - Street 2:
Mailing Address - City:KALAMA
Mailing Address - State:WA
Mailing Address - Zip Code:98625
Mailing Address - Country:US
Mailing Address - Phone:360-751-0411
Mailing Address - Fax:
Practice Address - Street 1:208 CHURCH ST
Practice Address - Street 2:
Practice Address - City:KELSO
Practice Address - State:WA
Practice Address - Zip Code:98626-3409
Practice Address - Country:US
Practice Address - Phone:360-751-0411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA10032225700000X
WAAC60338798171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty