Provider Demographics
NPI:1013542067
Name:SCHLAIS, KATHLEEN T
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:T
Last Name:SCHLAIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:CLIFFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:605 BRADLEY DR APT C
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-2244
Mailing Address - Country:US
Mailing Address - Phone:847-987-6688
Mailing Address - Fax:
Practice Address - Street 1:605 BRADLEY DR APT C
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-2244
Practice Address - Country:US
Practice Address - Phone:847-987-6688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-10
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146015342235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist