Provider Demographics
NPI:1497972814
Name:SCHNEIDER, CAROLYN GAIL (AM)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:GAIL
Last Name:SCHNEIDER
Suffix:
Gender:F
Credentials:AM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W DIVERSEY PKWY
Mailing Address - Street 2:SUITE 275
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1879
Mailing Address - Country:US
Mailing Address - Phone:773-281-7200
Mailing Address - Fax:773-281-7201
Practice Address - Street 1:1000 W DIVERSEY PKWY
Practice Address - Street 2:SUITE 275
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1879
Practice Address - Country:US
Practice Address - Phone:312-458-9679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-001970101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional