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NPI Code Detail

MEDICARE: LISA M SCHWAB LCPC

MEDICARE:   LISA M SCHWAB  LCPC
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
1101YP2500XProfessional Counselor180.006530IL

General Provider Information

NPI Number : 1386830156
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA M SCHWAB LCPC
Provider Business Mailing Address
First Line : 4211 N PROSPECT RD
Second Line :
City : PEORIA HEIGHTS
State : IL
Zip : 61616-7754
Country : US
Telephone Number : 309-712-7996
Fax Number :
Provider Business Practice Location Address
First Line : 4211 N PROSPECT RD
Second Line :
City : PEORIA HEIGHTS
State : IL
Zip : 61616-7754
Country : US
Telephone Number : 309-712-7996
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2007
Last Update Date : 04/11/2019

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Directions to “ LISA M SCHWAB LCPC” Practice Location

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