Healthcare Provider Details

I. General information

NPI: 1689183402
Provider Name (Legal Business Name): KAYCEE ENYART M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2017
Last Update Date: 12/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 E GARFIELD AVE
DECATUR IL
62526-4550
US

IV. Provider business mailing address

2105 N SUMMIT AVE
DECATUR IL
62526-3457
US

V. Phone/Fax

Practice location:
  • Phone: 217-362-3360
  • Fax:
Mailing address:
  • Phone: 217-841-5676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146.011253
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: