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General NPI Number Information
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NPI Number | 1932892171
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Entity Type | Individual
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Provider Name | AMI BOUTERSE
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Gender | Female
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Dates
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Enumeration Date | 06/02/2023
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Last Update Date | 06/02/2023
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Provider Practice Location Address
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Address Line | 4235 GREEN BAY RD
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City | KENOSHA
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State | WI
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Zip | 53144-4516
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Country | US
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Telephone | 262-652-1418
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Fax |
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Provider Business Mailing Address
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Address Line | 10319 81ST ST
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City | PLEASANT PRAIRIE
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State | WI
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Zip | 53158-2028
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Country | US
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Telephone | 262-818-3563
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 6206-154
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License Number State | WI
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