Basic Information
| Provider Information | |||||||||
| NPI: | 1942687058 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHREIBER | ||||||||
| FirstName: | KAITLIN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3080 W LAKE AVE | ||||||||
| Address2: | |||||||||
| City: | GLENVIEW | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600261210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8477242620 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1825 W NORTH AVE APT 3B | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606221309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8479422131 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2015 | ||||||||
| LastUpdateDate: | 09/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 150.015530 | IL | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | 149.023476 | IL | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.