Healthcare Provider Details

I. General information

NPI: 1053821009
Provider Name (Legal Business Name): RYAN NICOLE SCHILLER LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2017
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 STILLWATER DR
HAINESVILLE IL
60030-4127
US

IV. Provider business mailing address

165 STILLWATER DR
HAINESVILLE IL
60030-4127
US

V. Phone/Fax

Practice location:
  • Phone: 815-685-0345
  • Fax:
Mailing address:
  • Phone: 815-685-0345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180012413
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: