Provider Demographics
NPI:1932541752
Name:BERGSCHNEIDER, KATHRYN NOELE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:KATHRYN
Middle Name:NOELE
Last Name:BERGSCHNEIDER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:BERGSCHNEIDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:701 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62693-9013
Mailing Address - Country:US
Mailing Address - Phone:217-502-0061
Mailing Address - Fax:
Practice Address - Street 1:701 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62693-9013
Practice Address - Country:US
Practice Address - Phone:217-502-0061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.011626235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist