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NPI Code Detail

MEDICARE: AMY J WILMA M.A.-CCC/SLP

MEDICARE: AMY J WILMA M.A.-CCC/SLP
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
1235Z00000XSpeech-Language Pathologist8328MN

General Provider Information

NPI Number : 1245471697
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY J WILMA M.A.-CCC/SLP
Provider Business Mailing Address
First Line : 1200 SHAKOPEE TOWN SQ
Second Line :
City : SHAKOPEE
State : MN
Zip : 55379-1902
Country : US
Telephone Number : 952-496-5922
Fax Number : 952-496-5935
Provider Business Practice Location Address
First Line : 1200 SHAKOPEE TOWN SQ
Second Line :
City : SHAKOPEE
State : MN
Zip : 55379-1902
Country : US
Telephone Number : 952-496-5000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2009
Last Update Date : 05/11/2026

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