Provider Demographics
NPI:1073119947
Name:CARTER SCHNELL, GEFFAN AC (SLP)
Entity Type:Individual
Prefix:MS
First Name:GEFFAN
Middle Name:AC
Last Name:CARTER SCHNELL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:GEFFAN
Other - Middle Name:AC
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:3373 BASIL DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-7213
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3373 BASIL DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-7213
Practice Address - Country:US
Practice Address - Phone:507-951-9067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-07
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6460235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1073119947Medicaid