Provider Demographics
NPI:1568457885
Name:SCHALLER, ILENE FAY (MSW LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ILENE
Middle Name:FAY
Last Name:SCHALLER
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 1:4208 KENSINGTON DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-4550
Mailing Address - Country:US
Mailing Address - Phone:816-233-9998
Mailing Address - Fax:816-279-9666
Practice Address - Street 1:4208 KENSINGTON DR
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-4550
Practice Address - Country:US
Practice Address - Phone:816-233-9998
Practice Address - Fax:816-279-9666
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002698103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO35978015OtherBLUE CROSS/BLUE SHIELD