Provider Demographics
NPI:1760673016
Name:SCHLIFE, JENNIFER (LISW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:SCHLIFE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:SCHLIFE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:5005 PROSPECT AVE NE STE C
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-4283
Mailing Address - Country:US
Mailing Address - Phone:708-921-0683
Mailing Address - Fax:
Practice Address - Street 1:5005 PROSPECT AVE NE STE C
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4283
Practice Address - Country:US
Practice Address - Phone:708-921-0683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490103341041C0700X
NMI-068731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP97401Medicare UPIN
ILK00868Medicare PIN