Provider Demographics
NPI:1326317801
Name:SCHMIDT, ANITA LYNN (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:ANITA
Middle Name:LYNN
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 S WAUKEGAN RD STE A8
Mailing Address - Street 2:PMB 1079
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-2665
Mailing Address - Country:US
Mailing Address - Phone:847-786-5682
Mailing Address - Fax:
Practice Address - Street 1:825 S WAUKEGAN ROAD
Practice Address - Street 2:SUITE A8 PMB 1079
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-6004
Practice Address - Country:US
Practice Address - Phone:847-786-5682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-29
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150013239104100000X
COCSW.099280381041C0700X
IL149.0185061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker