Provider Demographics
NPI:1174978860
Name:SCHAEDLER, LISA (LSW LCSW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:SCHAEDLER
Suffix:
Gender:F
Credentials:LSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4774 HILL TRAIL RD APT 2C
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-3824
Mailing Address - Country:US
Mailing Address - Phone:785-408-0775
Mailing Address - Fax:
Practice Address - Street 1:4774 HILL TRAIL RD APT 2C
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532
Practice Address - Country:US
Practice Address - Phone:785-408-0775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-29
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150102173104100000X
IL1490203381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker