Healthcare Provider Details

I. General information

NPI: 1730500455
Provider Name (Legal Business Name): KATIE KELLEY SCHNEIDER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CATHERINE SCHNEIDER

II. Dates (important events)

Enumeration Date: 12/23/2013
Last Update Date: 12/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N ASHLAND AVE
CHICAGO IL
60622-2259
US

IV. Provider business mailing address

1200 N ASHLAND AVE
CHICAGO IL
60622-2259
US

V. Phone/Fax

Practice location:
  • Phone: 773-850-2295
  • Fax:
Mailing address:
  • Phone: 773-850-2295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.009610
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: