Provider Demographics
NPI:1073336061
Name:SCHNEIDER, KAITLIN
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:SCHNEIDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 CHADWICK DR
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-1920
Mailing Address - Country:US
Mailing Address - Phone:630-973-8361
Mailing Address - Fax:
Practice Address - Street 1:205 N ADAMS ST
Practice Address - Street 2:
Practice Address - City:FLANAGAN
Practice Address - State:IL
Practice Address - Zip Code:61740-9036
Practice Address - Country:US
Practice Address - Phone:815-844-7115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146012778235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist