MEDICARE: HAILEY ELIZABETH SCHROEDER

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1902176407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAILEY ELIZABETH SCHROEDER

Provider Business Mailing Address
First Line	:	5001 N SAWYER AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-4951
Country	:	US
Telephone Number	:	602-481-2009
Fax Number	:

Provider Business Practice Location Address
First Line	:	5001 N SAWYER AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-4951
Country	:	US
Telephone Number	:	602-481-2009
Fax Number	:

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

Provider Enumeration Date	:	12/31/2011
Last Update Date	:	09/29/2022

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