Provider Demographics
NPI:1386251825
Name:SCHULTZ, KARIE A (PEL)
Entity type:Individual
Prefix:
First Name:KARIE
Middle Name:A
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:PEL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 S EWING ST
Mailing Address - Street 2:
Mailing Address - City:ALTAMONT
Mailing Address - State:IL
Mailing Address - Zip Code:62411-1265
Mailing Address - Country:US
Mailing Address - Phone:618-483-6195
Mailing Address - Fax:618-483-6303
Practice Address - Street 1:407 S EDWARDS ST
Practice Address - Street 2:
Practice Address - City:ALTAMONT
Practice Address - State:IL
Practice Address - Zip Code:62411-1701
Practice Address - Country:US
Practice Address - Phone:618-483-5171
Practice Address - Fax:618-483-6793
Is Sole Proprietor?:No
Enumeration Date:2020-09-29
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL196458235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL196458OtherIEIN