Provider Demographics
NPI:1518664416
Name:SCHICHTEL, LYNN SARAH
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:SARAH
Last Name:SCHICHTEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2344 S STATE ST APT 512
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2414
Mailing Address - Country:US
Mailing Address - Phone:970-227-5051
Mailing Address - Fax:
Practice Address - Street 1:10215 W ROOSEVELT RD STE 101
Practice Address - Street 2:
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154-2576
Practice Address - Country:US
Practice Address - Phone:708-450-5762
Practice Address - Fax:708-938-5283
Is Sole Proprietor?:No
Enumeration Date:2023-02-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant