Basic Information
| Provider Information | |||||||||
| NPI: | 1619236031 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHAFFER | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | |||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3277 WESTERN AVE | ||||||||
| Address2: | |||||||||
| City: | HIGHLAND PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600351200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7737459870 | ||||||||
| FaxNumber: | 7737459901 | ||||||||
| Practice Location | |||||||||
| Address1: | 5825 W BELMONT AVE | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606345203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7737459870 | ||||||||
| FaxNumber: | 7737459901 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2012 | ||||||||
| LastUpdateDate: | 05/04/2012 | ||||||||
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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 | 149009022 | IL | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.