Healthcare Provider Details

I. General information

NPI: 1255959755
Provider Name (Legal Business Name): ABIGAIL SCHULDT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2020
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 E WINTER AVE
DANVILLE IL
61832-2295
US

IV. Provider business mailing address

1605 BUNKER CT
URBANA IL
61802-4715
US

V. Phone/Fax

Practice location:
  • Phone: 217-651-6801
  • Fax: 217-651-6801
Mailing address:
  • Phone: 815-383-6830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: