1104282045 NPI number — COLETTE T. SCHEUERMANN

Table of content: (NPI 1104282045)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104282045 NPI number — COLETTE T. SCHEUERMANN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLETTE T. SCHEUERMANN
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104282045
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/30/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8047 TAUREN CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NAPLES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34119-7718
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-359-7917
Provider Business Mailing Address Fax Number:
847-359-7917

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8047 TAUREN CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NAPLES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-359-7917
Provider Business Practice Location Address Fax Number:
847-359-7917
Provider Enumeration Date:
01/07/2016

Additional Information

Authorized Official

Authorized Official Last Name:
SCHEUERMANN
Authorized Official First Name:
COLETTE
Authorized Official Middle Name:
THERESE
Authorized Official Title or Position:
LICENSED CLINICAL SOCIAL WORKER
Authorized Official Telephone Number:
847-359-7917

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  SW13074 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YM0800X , with the licence number: 149003493 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1014M0800X , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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