Provider Demographics
NPI:1437746294
Name:SCHAUB, TELENA RAE (SLP)
Entity Type:Individual
Prefix:
First Name:TELENA
Middle Name:RAE
Last Name:SCHAUB
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10808 N GLENFIELD DR
Mailing Address - Street 2:
Mailing Address - City:DUNLAP
Mailing Address - State:IL
Mailing Address - Zip Code:61525-9688
Mailing Address - Country:US
Mailing Address - Phone:309-453-2164
Mailing Address - Fax:
Practice Address - Street 1:10808 N GLENFIELD DR
Practice Address - Street 2:
Practice Address - City:DUNLAP
Practice Address - State:IL
Practice Address - Zip Code:61525-9688
Practice Address - Country:US
Practice Address - Phone:309-453-2164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242006004235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist