Provider Demographics
NPI:1467963512
Name:OLIGSCHLAEGER, MARNELLE KATHRYN (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARNELLE
Middle Name:KATHRYN
Last Name:OLIGSCHLAEGER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1322 COUNTY HIGHWAY 30
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62565-4453
Mailing Address - Country:US
Mailing Address - Phone:217-827-3865
Mailing Address - Fax:
Practice Address - Street 1:1101 WN 6TH ST
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62565
Practice Address - Country:US
Practice Address - Phone:217-774-2169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-17
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.004987235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist