Provider Demographics
NPI:1114441912
Name:SCHMALENSEE, KRISTA (MS, CCC-SLP/L)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:SCHMALENSEE
Suffix:
Gender:F
Credentials:MS, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7576 CREEK BND
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-6666
Mailing Address - Country:US
Mailing Address - Phone:815-621-6324
Mailing Address - Fax:
Practice Address - Street 1:1031 5TH AVE
Practice Address - Street 2:
Practice Address - City:BELVIDERE
Practice Address - State:IL
Practice Address - Zip Code:61008-5139
Practice Address - Country:US
Practice Address - Phone:815-547-6734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-02
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146012088235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist