MEDICARE: AMY SCHLEY PHD SC

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	103T00000X	Psychologist	1037	WI

General Provider Information

NPI Number	:	1396925004
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMY SCHLEY PHD SC

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	:	CLINIC MANAGER
Name	:	DANIEL J SMITH
Credential	:
Telephone Number	:	262-542-6694

Provider Enumeration Date	:	11/09/2007
Last Update Date	:	11/09/2007

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