Healthcare Provider Details

I. General information

NPI: 1164988879
Provider Name (Legal Business Name): VICTORIA MERRITT WINTERROSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VICTORIA MERRITT SCHIMMER

II. Dates (important events)

Enumeration Date: 02/18/2019
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 PEORIA ST
PERU IL
61354-3262
US

IV. Provider business mailing address

727 CLANCY DR
DALZELL IL
61320-9758
US

V. Phone/Fax

Practice location:
  • Phone: 815-780-0690
  • Fax: 815-410-1937
Mailing address:
  • Phone: 815-503-2521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149025379
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: