MEDICARE: DR. AMY M SCHLEY PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC2200X	Clinical Child & Adolescent Psychologist	1196-057	WI

General Provider Information

NPI Number	:	1073683413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMY M SCHLEY PHD

Provider Business Mailing Address
First Line	:	204 WISCONSIN AVE
Second Line	:
City	:	WAUKESHA
State	:	WI
Zip	:	53186-4927
Country	:	US
Telephone Number	:	262-542-6694
Fax Number	:	262-542-6213

Provider Business Practice Location Address
First Line	:	204 WISCONSIN AVE
Second Line	:
City	:	WAUKESHA
State	:	WI
Zip	:	53186-4927
Country	:	US
Telephone Number	:	262-542-6694
Fax Number	:	262-542-6213

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	07/08/2007

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