Provider Demographics
NPI:1750393906
Name:EIESLAND-SCHULTZ, INGER (LCSW)
Entity type:Individual
Prefix:
First Name:INGER
Middle Name:
Last Name:EIESLAND-SCHULTZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 S NAPERVILLE RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-8155
Mailing Address - Country:US
Mailing Address - Phone:630-462-7005
Mailing Address - Fax:630-562-7005
Practice Address - Street 1:423 CENTRAL AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-3035
Practice Address - Country:US
Practice Address - Phone:847-784-8814
Practice Address - Fax:847-784-9504
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker