1063964526 NPI number — AMY SCHAFFARZICK SLP-CCC

Table of content: AMY SCHAFFARZICK SLP-CCC (NPI 1063964526)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063964526 NPI number — AMY SCHAFFARZICK SLP-CCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHAFFARZICK
Provider First Name:
AMY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
SLP-CCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063964526
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 570
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNTAIN VIEW
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82939-0570
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-782-6602
Provider Business Mailing Address Fax Number:
307-782-7328

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1208 ELK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KEMMERER
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
83101-3916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-877-6984
Provider Business Practice Location Address Fax Number:
307-877-9650
Provider Enumeration Date:
11/01/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SP-859 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)