Healthcare Provider Details

I. General information

NPI: 1821184755
Provider Name (Legal Business Name): AMY B SKIVER MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 GEORGE ST STE 108
DE PERE WI
54115-2773
US

IV. Provider business mailing address

416 GEORGE ST STE 108
DE PERE WI
54115-2773
US

V. Phone/Fax

Practice location:
  • Phone: 920-645-2810
  • Fax:
Mailing address:
  • Phone: 920-645-2810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number375112S
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: