Healthcare Provider Details

I. General information

NPI: 1013886209
Provider Name (Legal Business Name): SAMANTHA SCHAFER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2025
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 W OHIO ST STE 410E
CHICAGO IL
60654-7854
US

IV. Provider business mailing address

320 W OHIO ST STE 410E
CHICAGO IL
60654-7854
US

V. Phone/Fax

Practice location:
  • Phone: 888-928-5278
  • Fax: 815-720-4939
Mailing address:
  • Phone: 888-928-5278
  • Fax: 815-720-4939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209.033867
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: