Provider Demographics
NPI:1386830156
Name:SCHWAB, LISA M (LCPC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:SCHWAB
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4211 N PROSPECT RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:61616-7754
Mailing Address - Country:US
Mailing Address - Phone:309-712-7996
Mailing Address - Fax:
Practice Address - Street 1:4211 N PROSPECT RD
Practice Address - Street 2:
Practice Address - City:PEORIA HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:61616-7754
Practice Address - Country:US
Practice Address - Phone:309-712-7996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-14
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.006530101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL088$$$$$$$$$001Medicaid