Provider Demographics
NPI:1881764025
Name:SCHULTZ, SARAH MARIE (MS CCC SLP)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:MARIE
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:MARIE
Other - Last Name:MOGILKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:744 S WEBSTER AVE
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-3505
Mailing Address - Country:US
Mailing Address - Phone:920-445-7226
Mailing Address - Fax:920-445-7289
Practice Address - Street 1:926 WILLARD DR
Practice Address - Street 2:SUITE 114
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304
Practice Address - Country:US
Practice Address - Phone:920-592-9330
Practice Address - Fax:920-592-9320
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2727154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42571800Medicaid