Healthcare Provider Details

I. General information

NPI: 1386236172
Provider Name (Legal Business Name): JILLIAN SCHULZE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2021
Last Update Date: 02/03/2021
Certification Date: 01/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9119 S EXCHANGE AVE
CHICAGO IL
60617-4225
US

IV. Provider business mailing address

502 MORNINGSIDE AVE
MADISON WI
53716-1737
US

V. Phone/Fax

Practice location:
  • Phone: 773-768-5000
  • Fax:
Mailing address:
  • Phone: 608-239-7177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number149.022850
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: