1356481766 NPI number — MS. POLLY L SCHINK MS CCC SLP

Table of content: MS. POLLY L SCHINK MS CCC SLP (NPI 1356481766)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356481766 NPI number — MS. POLLY L SCHINK MS CCC SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHINK
Provider First Name:
POLLY
Provider Middle Name:
L
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS CCC SLP
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:
1356481766
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1029 QUINCY STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STURGEON BAY
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54235
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-495-3751
Provider Business Mailing Address Fax Number:
920-592-9320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
926 WILLARD DR
Provider Second Line Business Practice Location Address:
SUITE 114
Provider Business Practice Location Address City Name:
GREEN BAY
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-592-9330
Provider Business Practice Location Address Fax Number:
920-592-9320
Provider Enumeration Date:
02/07/2007

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:  2213154 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 42789600 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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