Healthcare Provider Details

I. General information

NPI: 1063468874
Provider Name (Legal Business Name): MARC A SCHNEIDER PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MARC SCHNEIDER PSY.D.

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 02/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1341 WARREN AVE
DOWNERS GROVE IL
60515-3437
US

IV. Provider business mailing address

1341 WARREN AVE
DOWNERS GROVE IL
60515-3437
US

V. Phone/Fax

Practice location:
  • Phone: 630-719-5454
  • Fax: 630-719-1263
Mailing address:
  • Phone: 630-719-5454
  • Fax: 630-719-1263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071-003737
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: