Provider Demographics
NPI:1447262969
Name:SCHLOEMANN, COLLEEN D (LCSW)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:D
Last Name:SCHLOEMANN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 W HERRIN ST
Mailing Address - Street 2:
Mailing Address - City:HERRIN
Mailing Address - State:IL
Mailing Address - Zip Code:62948-6433
Mailing Address - Country:US
Mailing Address - Phone:618-988-8267
Mailing Address - Fax:
Practice Address - Street 1:2001 W HERRIN ST
Practice Address - Street 2:
Practice Address - City:HERRIN
Practice Address - State:IL
Practice Address - Zip Code:62948-6433
Practice Address - Country:US
Practice Address - Phone:618-988-8267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL540130Medicare ID - Type Unspecified