Healthcare Provider Details

I. General information

NPI: 1609960996
Provider Name (Legal Business Name): JUDITH MICHELLE SCHLAEGER CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 11/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 EAST 51ST STREET PROVIDENT HOSPITAL OF COOK COUNTY
CHICAGO IL
60615-2400
US

IV. Provider business mailing address

2655 W PETERSON AVE
CHICAGO IL
60659-4017
US

V. Phone/Fax

Practice location:
  • Phone: 312-572-1200
  • Fax: 312-572-1294
Mailing address:
  • Phone: 773-271-8880
  • Fax: 773-271-7435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number209001907
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: