Provider Demographics
NPI:1467684126
Name:SCHNACK, KELSI JO (MS/CCC-SLP/L)
Entity type:Individual
Prefix:MRS
First Name:KELSI
Middle Name:JO
Last Name:SCHNACK
Suffix:
Gender:F
Credentials:MS/CCC-SLP/L
Other - Prefix:MS
Other - First Name:KELSI
Other - Middle Name:JO
Other - Last Name:SNAKENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12705 25TH STREET CT
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:IL
Mailing Address - Zip Code:61264-4964
Mailing Address - Country:US
Mailing Address - Phone:309-278-3766
Mailing Address - Fax:
Practice Address - Street 1:801 SW 9TH ST
Practice Address - Street 2:
Practice Address - City:ALEDO
Practice Address - State:IL
Practice Address - Zip Code:61231-2316
Practice Address - Country:US
Practice Address - Phone:309-582-5350
Practice Address - Fax:309-582-3457
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.011607235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist