Provider Demographics
NPI:1598050312
Name:SCHWENKER, MARY ANGELA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANGELA
Last Name:SCHWENKER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3121 WESTMAR DR
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-2608
Mailing Address - Country:US
Mailing Address - Phone:563-340-8175
Mailing Address - Fax:
Practice Address - Street 1:17990 SPENCER RD
Practice Address - Street 2:
Practice Address - City:PLEASANT VALLEY
Practice Address - State:IA
Practice Address - Zip Code:52767
Practice Address - Country:US
Practice Address - Phone:563-332-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009013315235Z00000X
OR13467235Z00000X
IA002245235Z00000X
IL146011721235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist