Provider Demographics
NPI:1104479138
Name:SCHMELTER, SHANNON L
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:L
Last Name:SCHMELTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 S CADWELL AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-5363
Mailing Address - Country:US
Mailing Address - Phone:312-286-4852
Mailing Address - Fax:
Practice Address - Street 1:1434 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ST. CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-2374
Practice Address - Country:US
Practice Address - Phone:630-286-0026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician