MEDICARE: MRS. ALINE S. SCHULTZ 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	1041C0700X	Clinical Social Worker		IL

General Provider Information

NPI Number	:	1780693366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALINE S. SCHULTZ LCSW

Provider Business Mailing Address
First Line	:	1011 DOBSON ST
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60202-3816
Country	:	US
Telephone Number	:	847-492-1627
Fax Number	:

Provider Business Practice Location Address
First Line	:	2542 W NORTH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-5216
Country	:	US
Telephone Number	:	773-365-3005
Fax Number	:

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	07/08/2007

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