Provider Demographics
NPI:1467227058
Name:SCHROEDER, JOHN RANDALL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:RANDALL
Last Name:SCHROEDER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3938 W 111TH ST APT 2A
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60655-4048
Mailing Address - Country:US
Mailing Address - Phone:708-890-9400
Mailing Address - Fax:
Practice Address - Street 1:3938 W 111TH ST APT 2A
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60655-4048
Practice Address - Country:US
Practice Address - Phone:708-890-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-24
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490236351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical