Provider Demographics
NPI:1699142000
Name:SCHILLING, KIA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KIA
Middle Name:
Last Name:SCHILLING
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1375 VILLA PARK CIR APT 6
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54302-6114
Mailing Address - Country:US
Mailing Address - Phone:608-412-2728
Mailing Address - Fax:
Practice Address - Street 1:1375 VILLA PARK CIR APT 6
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54302-6114
Practice Address - Country:US
Practice Address - Phone:608-412-2728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-01
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4199 - 154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist