Healthcare Provider Details

I. General information

NPI: 1639003635
Provider Name (Legal Business Name): AMY SCHWAPPACH RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 WESTON POINTE DR
SPRINGFIELD IL
62704-6568
US

IV. Provider business mailing address

1420 WESTON POINTE DR
SPRINGFIELD IL
62704-6568
US

V. Phone/Fax

Practice location:
  • Phone: 217-691-3828
  • Fax:
Mailing address:
  • Phone: 217-691-3828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164.012276
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: