Provider Demographics
NPI:1952899395
Name:SCHULTZ, NANCY L (LCSW)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:L
Last Name: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 1:3204 EAGLE WAY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60678-1032
Mailing Address - Country:US
Mailing Address - Phone:630-717-2258
Mailing Address - Fax:
Practice Address - Street 1:25480 W CEDAR CREST LN
Practice Address - Street 2:
Practice Address - City:LAKE VILLA
Practice Address - State:IL
Practice Address - Zip Code:60046-8256
Practice Address - Country:US
Practice Address - Phone:847-356-8205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-01
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0068091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical