Provider Demographics
NPI:1073598637
Name:SCHNEIDER, MICHAEL JOSEPH (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:SCHNEIDER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4608 WOODLAND TRL
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62305-9151
Mailing Address - Country:US
Mailing Address - Phone:217-223-6593
Mailing Address - Fax:
Practice Address - Street 1:1231 MAINE ST
Practice Address - Street 2:SUITE # 1
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-4274
Practice Address - Country:US
Practice Address - Phone:217-228-1887
Practice Address - Fax:217-228-1884
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPY01367103TC0700X
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK15605Medicare ID - Type UnspecifiedDAVKEN & ASSOCIATES