Provider Demographics
NPI:1104345669
Name:SCHIRMER, TOBIAS V
Entity type:Individual
Prefix:
First Name:TOBIAS
Middle Name:V
Last Name:SCHIRMER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 MCKINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE VILLA
Mailing Address - State:IL
Mailing Address - Zip Code:60046-8986
Mailing Address - Country:US
Mailing Address - Phone:847-245-8459
Mailing Address - Fax:847-356-0833
Practice Address - Street 1:PALOMBI MIDDLE SCHOOL
Practice Address - Street 2:133 SOUTH MCKINLEY
Practice Address - City:LAKE VILLA
Practice Address - State:IL
Practice Address - Zip Code:60046
Practice Address - Country:US
Practice Address - Phone:847-245-8459
Practice Address - Fax:847-356-0833
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-15
Last Update Date:2017-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2086880235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty