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General NPI Number Information
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NPI Number | 1326144510
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Entity Type | Individual
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Provider Name | SUSAN E. SCHMIDT
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Gender | Female
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1010 WEST 95TH STREET
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City | CHICAGO
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State | IL
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Zip | 60643
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Country | US
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Telephone | 630-922-6791
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Fax | 630-922-6792
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Provider Business Mailing Address
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Address Line | 3023 BENNETT DRIVE
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City | NAPERVILLE
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State | IL
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Zip | 60564-5176
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Country | US
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Telephone | 630-922-6791
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Fax | 630-922-6792
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071.004822
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License Number State | IL
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