Healthcare Provider Details

I. General information

NPI: 1265353700
Provider Name (Legal Business Name): JESSICA SCHWARTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12938 COLDWATER RD
FORT WAYNE IN
46845-9517
US

IV. Provider business mailing address

1407 CHANTERELLE DR
FORT WAYNE IN
46845-1575
US

V. Phone/Fax

Practice location:
  • Phone: 260-619-4522
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22005935A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: