Provider Demographics
NPI:1720380066
Name:SCHACK, ELEANOR (MA,CCC)
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:
Last Name:SCHACK
Suffix:
Gender:F
Credentials:MA,CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12695 SW 105TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-4707
Mailing Address - Country:US
Mailing Address - Phone:305-274-7883
Mailing Address - Fax:305-274-4271
Practice Address - Street 1:10725 SW 104TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-8162
Practice Address - Country:US
Practice Address - Phone:305-274-7883
Practice Address - Fax:305-274-4271
Is Sole Proprietor?:No
Enumeration Date:2010-11-18
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 6794235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist