Healthcare Provider Details

I. General information

NPI: 1184035347
Provider Name (Legal Business Name): BETH SCHIFF PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2014
Last Update Date: 05/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 SALEM LN
EVANSTON IL
60203-1217
US

IV. Provider business mailing address

49 SALEM LN
EVANSTON IL
60203-1217
US

V. Phone/Fax

Practice location:
  • Phone: 847-676-4404
  • Fax:
Mailing address:
  • Phone: 847-676-4404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1279236
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: