Provider Demographics
NPI:1770249278
Name:SCHWARZKOPF, CHELSEA MARIE
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:MARIE
Last Name:SCHWARZKOPF
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 1:650 N CONVENT ST
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-1320
Mailing Address - Country:US
Mailing Address - Phone:815-532-7268
Mailing Address - Fax:
Practice Address - Street 1:650 N CONVENT ST
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-1320
Practice Address - Country:US
Practice Address - Phone:815-523-7268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-10
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLS621113986440106S00000X
IL1-24-75259103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician