Provider Demographics
NPI:1831250828
Name:SCHENK, PATRICIA ANN (MS,CCC-SLP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:SCHENK
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 1:809 S 15TH ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-5206
Mailing Address - Country:US
Mailing Address - Phone:217-221-9597
Mailing Address - Fax:
Practice Address - Street 1:6000 HOSPITAL DR.
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401
Practice Address - Country:US
Practice Address - Phone:573-248-5346
Practice Address - Fax:573-248-5364
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005014367235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist