=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932895430
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SCHWABA PSYCHOTHERAPY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2023
-----------------------------------------------------
Last Update Date | 04/17/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 222 S PROSPECT AVE # 324
-----------------------------------------------------
City | PARK RIDGE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60068-4037
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-234-1509
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 222 S PROSPECT AVE # 324
-----------------------------------------------------
City | PARK RIDGE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60068-4037
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-234-1509
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MELANIE LAUREN NIEPSUJ SCHWABA
-----------------------------------------------------
Credential | LCSW CADC
-----------------------------------------------------
Telephone | 773-234-1509
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------