Healthcare Provider Details

I. General information

NPI: 1235469289
Provider Name (Legal Business Name): AMY MARIE IMME
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2010
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 KAPHAEM RD
TOMAHAWK WI
54487-7800
US

IV. Provider business mailing address

230238 PINE HILLS DR
WAUSAU WI
54403-7243
US

V. Phone/Fax

Practice location:
  • Phone: 715-453-2141
  • Fax:
Mailing address:
  • Phone: 501-920-7394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1001476984
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: