Provider Demographics
NPI:1770641441
Name:SCHNEIDER, JESSICA (MA LCSW)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:
Last Name:SCHNEIDER
Suffix:
Gender:F
Credentials:MA LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 NO MICHIGAN AVE
Mailing Address - Street 2:SUITE 1610
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602
Mailing Address - Country:US
Mailing Address - Phone:312-332-0298
Mailing Address - Fax:847-604-9812
Practice Address - Street 1:30 NO MICHIGAN AVE
Practice Address - Street 2:SUITE 1610
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602
Practice Address - Country:US
Practice Address - Phone:312-332-0298
Practice Address - Fax:847-604-9812
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490000291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
088242OtherMANAGED HLTH NTWK
000227498OtherUNITED BEHAVIORAL HEALTH
025471OtherVALUE OPTIONS
088242OtherMANAGED HLTH NTWK