Provider Demographics
NPI:1912558834
Name:SCHIRACK, KALYN NICHOLE
Entity Type:Individual
Prefix:
First Name:KALYN
Middle Name:NICHOLE
Last Name:SCHIRACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:872 62ND STREET CIR E STE 101103
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-6238
Mailing Address - Country:US
Mailing Address - Phone:941-251-6825
Mailing Address - Fax:941-201-1626
Practice Address - Street 1:872 62ND STREET CIR E STE 101-103
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-6238
Practice Address - Country:US
Practice Address - Phone:941-251-6825
Practice Address - Fax:941-201-1626
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ9340235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist