Individual
AMY SHACKELFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1703 60TH ST, KENOSHA, WI 53140-3986
(262) 658-4125
Mailing address
1703 60TH ST, KENOSHA, WI 53140-3986
(262) 658-4125
Taxonomy
Speciality
Code
Description
License number
State
174H00000X
Health Educator
Primary
1570-19
WI
Other
Enumeration date
11/05/2013
Last updated
11/05/2013
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