Healthcare Provider Details

I. General information

NPI: 1750200622
Provider Name (Legal Business Name): AMY LEE MATHWIG M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 W GREEN BAY ST
PULASKI WI
54162-9350
US

IV. Provider business mailing address

737 BORDEAUX RUE
GREEN BAY WI
54301-1454
US

V. Phone/Fax

Practice location:
  • Phone: 920-822-6118
  • Fax:
Mailing address:
  • Phone: 608-852-6366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: