Provider Demographics
NPI:1639207517
Name:SCHWARTZ, JONATHON (ST)
Entity Type:Individual
Prefix:
First Name:JONATHON
Middle Name:
Last Name:SCHWARTZ
Suffix:
Gender:M
Credentials:ST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 490210
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34749-0210
Mailing Address - Country:US
Mailing Address - Phone:352-326-4014
Mailing Address - Fax:352-326-4126
Practice Address - Street 1:13940 HWY 441
Practice Address - Street 2:BLDG 700 SUITE 702
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159
Practice Address - Country:US
Practice Address - Phone:352-751-6005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA3131235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSA3131OtherLICENSE #