Healthcare Provider Details

I. General information

NPI: 1003572140
Provider Name (Legal Business Name): MEREDITH SCHROEDER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2021
Last Update Date: 11/12/2021
Certification Date: 11/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 W LAKE ST STE 2S
CHICAGO IL
60661-1034
US

IV. Provider business mailing address

432 W SURF ST APT 309
CHICAGO IL
60657-7113
US

V. Phone/Fax

Practice location:
  • Phone: 847-323-9679
  • Fax:
Mailing address:
  • Phone: 605-870-0018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178.012920
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: