Provider Demographics
NPI:1366515058
Name:SCHWANTZ, MICHELLE LYNN (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LYNN
Last Name:SCHWANTZ
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:LYNN
Other - Last Name:KORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:2208 BAXTER CT
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-8575
Mailing Address - Country:US
Mailing Address - Phone:224-805-6345
Mailing Address - Fax:224-238-7876
Practice Address - Street 1:2208 BAXTER CT
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-8575
Practice Address - Country:US
Practice Address - Phone:224-805-6345
Practice Address - Fax:224-238-7876
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146007756235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01636335OtherBCBS PROVIDER NUMBER