| Lisa Schwab, Llc | |
|
4211 N Prospect Rd Peoria Heights IL 61616-7754 | |
| (309) 691-5502 | |
| Not Available |
| Full Name | Lisa Schwab, Llc |
|---|---|
| Speciality | Counselor |
| Location | 4211 N Prospect Rd, Peoria Heights, Illinois |
| Authorized Official Name and Position | Lisa Schwab (OWNER) |
| Authorized Official Contact | 3096915502 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lisa Schwab, Llc 4211 N Prospect Rd Peoria Heights IL 61616-7754 Ph: (309) 712-7996 | Lisa Schwab, Llc 4211 N Prospect Rd Peoria Heights IL 61616-7754 Ph: (309) 691-5502 |
| NPI Number | 1194193235 |
|---|---|
| Provider Enumeration Date | 09/07/2015 |
| Last Update Date | 04/13/2020 |
| Certification Date | 04/13/2020 |
| Medicare PECOS PAC ID | 1850688557 |
|---|---|
| Medicare Enrollment ID | O20160923000737 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194193235 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Jennifer Alexander |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992233977 PECOS PAC ID: 7214294297 Enrollment ID: I20171129001891 |
| Provider Name | Kerrie Jewell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417357054 PECOS PAC ID: 8729403605 Enrollment ID: I20200810001732 |
| Provider Name | Jason Thomas Davis |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1356870927 PECOS PAC ID: 3274983135 Enrollment ID: I20231219002418 |
| Provider Name | Lisa M Schwab |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1386830156 PECOS PAC ID: 4587951280 Enrollment ID: I20240220002366 |
| Provider Name | Madeline Karen Tippett |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1386332575 PECOS PAC ID: 7810332756 Enrollment ID: I20240229004005 |
| Provider Name | Jamie Lynn Sabo |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1760937007 PECOS PAC ID: 4284071994 Enrollment ID: I20240318000873 |
| Provider Name | Marissa Ann Brown |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1528841012 PECOS PAC ID: 6901243161 Enrollment ID: I20240322003040 |
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