Provider Demographics
NPI:1689183402
Name:ENYART, KAYCEE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KAYCEE
Middle Name:
Last Name:ENYART
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 N SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-3457
Mailing Address - Country:US
Mailing Address - Phone:217-841-5676
Mailing Address - Fax:
Practice Address - Street 1:620 E GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-4550
Practice Address - Country:US
Practice Address - Phone:217-362-3360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-25
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.011253235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist