Basic Information
| Provider Information | |||||||||
| NPI: | 1003922311 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHULTZ | ||||||||
| FirstName: | JAN | ||||||||
| MiddleName: | KELLER | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LISW LCSW BCD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1308 WAUKEGAN RD | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | GLENVIEW | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600253070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8774864140 | ||||||||
| FaxNumber: | 8475894140 | ||||||||
| Practice Location | |||||||||
| Address1: | 1308 WAUKEGAN RD | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | GLENVIEW | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600253070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8774864140 | ||||||||
| FaxNumber: | 8475894140 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2006 | ||||||||
| LastUpdateDate: | 04/08/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 149012618 | IL | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 19835 | OH | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 000465 | CT | N | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.