Healthcare Provider Details

I. General information

NPI: 1376979732
Provider Name (Legal Business Name): SAMANTHA JEAN SCHULTE M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2013
Last Update Date: 09/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1288 STONEHAVEN CIR
AURORA IL
60504-8409
US

IV. Provider business mailing address

12524 39TH AVE
PLEASANT PRAIRIE WI
53158-4200
US

V. Phone/Fax

Practice location:
  • Phone: 630-585-0552
  • Fax: 630-429-9411
Mailing address:
  • Phone: 262-496-2829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146011808
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: