MEDICARE: LISA ANNE SCHWAB

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	1041C0700X	Clinical Social Worker		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01636475	OTHER	IL	BCBSIL

General Provider Information

NPI Number	:	1386854313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA ANNE SCHWAB

Provider Business Mailing Address
First Line	:	654 S PARK BLVD
Second Line	:
City	:	GLEN ELLYN
State	:	IL
Zip	:	60137-6918
Country	:	US
Telephone Number	:	773-497-2789
Fax Number	:	630-942-0718

Provider Business Practice Location Address
First Line	:	1142 CHICAGO AVE
Second Line	:	SUITE 2 WEST
City	:	OAK PARK
State	:	IL
Zip	:	60302-1837
Country	:	US
Telephone Number	:	708-848-3635
Fax Number	:

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

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	07/08/2007

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