Provider Demographics
NPI:1184141533
Name:SCHWARTZ, KASEY ANN
Entity type:Individual
Prefix:
First Name:KASEY
Middle Name:ANN
Last Name:SCHWARTZ
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 1:113 PRAIRIE RD
Mailing Address - Street 2:
Mailing Address - City:CARTERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62918-2331
Mailing Address - Country:US
Mailing Address - Phone:618-713-5630
Mailing Address - Fax:
Practice Address - Street 1:121 N PARRISH LN
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-2024
Practice Address - Country:US
Practice Address - Phone:618-713-5630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-26
Last Update Date:2017-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.004663235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist