Provider Demographics
NPI:1013031012
Name:SCHAFFER, CAROLE ANN (MT)
Entity Type:Individual
Prefix:MS
First Name:CAROLE
Middle Name:ANN
Last Name:SCHAFFER
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4337 WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:STICKNEY
Mailing Address - State:IL
Mailing Address - Zip Code:60402-4261
Mailing Address - Country:US
Mailing Address - Phone:708-655-3711
Mailing Address - Fax:
Practice Address - Street 1:4337 WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:STICKNEY
Practice Address - State:IL
Practice Address - Zip Code:60402-4261
Practice Address - Country:US
Practice Address - Phone:708-655-3711
Practice Address - Fax:708-749-3716
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-17
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.001336174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist