Provider Demographics
NPI:1114376910
Name:SCHULTZ, AMY (AU)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:AU
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AU
Mailing Address - Street 1:925 W LOOP 281
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-2918
Mailing Address - Country:US
Mailing Address - Phone:903-247-3444
Mailing Address - Fax:903-247-3853
Practice Address - Street 1:925 W LOOP 281
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-2918
Practice Address - Country:US
Practice Address - Phone:903-247-3444
Practice Address - Fax:903-247-3853
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51603231H00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist