MEDICARE: JENNIFER MARIE SCHMIDT LCPC

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	101YM0800X	Mental Health Counselor	180-00517	IL

General Provider Information

NPI Number	:	1508945064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MARIE SCHMIDT LCPC

Provider Business Mailing Address
First Line	:	526 W STATE STREET
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61101-1214
Country	:	US
Telephone Number	:	815-968-9300
Fax Number	:	815-968-5314

Provider Business Practice Location Address
First Line	:	4751 MANHATTAN DR
Second Line	:	MANHATTAN COUNSELING CENTER
City	:	ROCKFORD
State	:	IL
Zip	:	61108-2264
Country	:	US
Telephone Number	:	815-720-4960
Fax Number	:	815-720-4970

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

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	07/08/2007

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