1356439442 NPI number — MS. THERESE N SCHMIDT LCSW

Table of content: MS. THERESE N SCHMIDT LCSW (NPI 1356439442)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356439442 NPI number — MS. THERESE N SCHMIDT LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHMIDT
Provider First Name:
THERESE
Provider Middle Name:
N
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCHMIDT
Provider Other First Name:
THERESE
Provider Other Middle Name:
N
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1356439442
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1580 N NORTHWEST HWY
Provider Second Line Business Mailing Address:
STE 121F
Provider Business Mailing Address City Name:
PARK RIDGE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60068
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-827-7639
Provider Business Mailing Address Fax Number:
847-827-7639

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1580 N NORTHWEST HWY
Provider Second Line Business Practice Location Address:
STE 121F
Provider Business Practice Location Address City Name:
PARK RIDGE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60068
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-827-7639
Provider Business Practice Location Address Fax Number:
847-827-7639
Provider Enumeration Date:
10/11/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  149000050 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)