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General NPI Number Information
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NPI Number | 1689183402
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Entity Type | Individual
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Provider Name | KAYCEE ENYART M.A., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 09/25/2017
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Last Update Date | 12/07/2017
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Provider Practice Location Address
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Address Line | 620 E GARFIELD AVE
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City | DECATUR
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State | IL
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Zip | 62526-4550
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Country | US
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Telephone | 217-362-3360
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Fax |
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Provider Business Mailing Address
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Address Line | 2105 N SUMMIT AVE
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City | DECATUR
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State | IL
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Zip | 62526-3457
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Country | US
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Telephone | 217-841-5676
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 146.011253
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License Number State | IL
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