MEDICARE: CAROLYN GAIL SCHNEIDER A.M.

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	101YP2500X	Professional Counselor	180-001970	IL

General Provider Information

NPI Number	:	1497972814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN GAIL SCHNEIDER A.M.

Provider Business Mailing Address
First Line	:	1000 W DIVERSEY PKWY
Second Line	:	SUITE 275
City	:	CHICAGO
State	:	IL
Zip	:	60614-1879
Country	:	US
Telephone Number	:	773-281-7200
Fax Number	:	773-281-7201

Provider Business Practice Location Address
First Line	:	1000 W DIVERSEY PKWY
Second Line	:	SUITE 275
City	:	CHICAGO
State	:	IL
Zip	:	60614-1879
Country	:	US
Telephone Number	:	312-458-9679
Fax Number	:

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

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	12/14/2017

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