1457650913 NPI number — KIMBERLY ANN SCHAFFER LCSW

Table of content: KIMBERLY ANN SCHAFFER LCSW (NPI 1457650913)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457650913 NPI number — KIMBERLY ANN SCHAFFER LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHAFFER
Provider First Name:
KIMBERLY
Provider Middle Name:
ANN
Provider Name Prefix Text:
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:
ARGABRIGHT OR NEWELL
Provider Other First Name:
KIMBERLY
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1457650913
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/25/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2050 LARKIN AVE STE 202
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELGIN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60123-5899
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-697-2400
Provider Business Mailing Address Fax Number:
847-697-2438

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2050 LARKIN AVE STE 202
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELGIN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60123-5899
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-697-2400
Provider Business Practice Location Address Fax Number:
847-697-2438
Provider Enumeration Date:
03/23/2011

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:  149008484 , 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)