MEDICARE: JANE T SCHMIT LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	222Q00000X	Developmental Therapist
2	1041C0700X	Clinical Social Worker	149004480	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0001627891	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1386743821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANE T SCHMIT LCSW

Provider Business Mailing Address
First Line	:	1201 S PRAIRIE AVE APT 2102
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60605-3425
Country	:	US
Telephone Number	:	773-882-5263
Fax Number	:	312-929-2991

Provider Business Practice Location Address
First Line	:	1201 S PRAIRIE AVE APT 2102
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60605-3425
Country	:	US
Telephone Number	:	773-882-5263
Fax Number	:	312-929-2991

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	12/30/2019

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