Healthcare Provider Details

I. General information

NPI: 1134365182
Provider Name (Legal Business Name): CARMEN JEAN SCHOTT LCSW, LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2008
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 EAGLE CTR STE B-1
O FALLON IL
62269-1946
US

IV. Provider business mailing address

9 RACHAEL CT
TROY IL
62294-4010
US

V. Phone/Fax

Practice location:
  • Phone: 618-982-3511
  • Fax: 618-726-2043
Mailing address:
  • Phone: 937-956-8498
  • Fax: 618-726-2043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.028271
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI 0700298
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: