Provider Demographics
NPI:1194975367
Name:SCHULTZ, TERESA L (MA CCC)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:L
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:MA CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 S 112TH ST
Mailing Address - Street 2:
Mailing Address - City:WALTON
Mailing Address - State:NE
Mailing Address - Zip Code:68461-9539
Mailing Address - Country:US
Mailing Address - Phone:402-202-2286
Mailing Address - Fax:
Practice Address - Street 1:1600 S 112TH ST
Practice Address - Street 2:
Practice Address - City:WALTON
Practice Address - State:NE
Practice Address - Zip Code:68461-9539
Practice Address - Country:US
Practice Address - Phone:402-202-2286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE332235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist