MEDICARE: MRS. MICHELLE LYNN SCHWANTZ M.A. CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	146007756	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01636335	OTHER	IL	BCBS PROVIDER NUMBER

General Provider Information

NPI Number	:	1366515058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MICHELLE LYNN SCHWANTZ M.A. CCC-SLP

Provider Business Mailing Address
First Line	:	2208 BAXTER CT
Second Line	:
City	:	ELGIN
State	:	IL
Zip	:	60123-8575
Country	:	US
Telephone Number	:	224-805-6345
Fax Number	:	224-238-7876

Provider Business Practice Location Address
First Line	:	2208 BAXTER CT
Second Line	:
City	:	ELGIN
State	:	IL
Zip	:	60123-8575
Country	:	US
Telephone Number	:	224-805-6345
Fax Number	:	224-238-7876

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	05/30/2013

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Directions to “ MRS. MICHELLE LYNN SCHWANTZ M.A. CCC-SLP” Practice Location

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