Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003065939 |
---|---|
Provider Name | Jon Lynn Schaefer |
First Address | Evanston, IL 60202-3334 |
Second Address | Highland Park, IL 60035 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2008 |
Last Update Date | 16/09/2008 |