Provider Demographics
NPI:1710058235
Name:SCHAFFNIT, NICOLE ANDREA (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANDREA
Last Name:SCHAFFNIT
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 1:2365 E 1400TH ST
Mailing Address - Street 2:
Mailing Address - City:MENDON
Mailing Address - State:IL
Mailing Address - Zip Code:62351-2821
Mailing Address - Country:US
Mailing Address - Phone:217-936-3187
Mailing Address - Fax:
Practice Address - Street 1:2365 E 1400TH ST
Practice Address - Street 2:
Practice Address - City:MENDON
Practice Address - State:IL
Practice Address - Zip Code:62351-2821
Practice Address - Country:US
Practice Address - Phone:217-936-3187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist