Provider Demographics
NPI:1699461210
Name:SCHMITZ, AMBER GRACE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:GRACE
Last Name:SCHMITZ
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 SOUTH ST APT 307
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-4854
Mailing Address - Country:US
Mailing Address - Phone:920-418-2227
Mailing Address - Fax:
Practice Address - Street 1:S11W29667 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-9476
Practice Address - Country:US
Practice Address - Phone:262-565-6124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist