=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336457787
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. JEANINE NANCY SCHWALM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2010
-----------------------------------------------------
Last Update Date | 09/20/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 160 ADAMS ST E
-----------------------------------------------------
City | EAST ISLIP
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11730-1624
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-286-4522
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 160 E ADAMS ST
-----------------------------------------------------
City | EAST ISLIP
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11730-1624
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-286-4522
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 0141371
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------