Provider Demographics
NPI:1689054009
Name:SCHWAB-FERGUSON, JEAN
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:SCHWAB-FERGUSON
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 1:1313 CHANCELLOR ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1618
Mailing Address - Country:US
Mailing Address - Phone:773-289-7510
Mailing Address - Fax:
Practice Address - Street 1:1313 CHANCELLOR ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1618
Practice Address - Country:US
Practice Address - Phone:773-289-7510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490105201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical