Provider Demographics
NPI:1275191942
Name:SCHRAMM, JACLYN (LCSW)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:SCHRAMM
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 1:3164 OLLERTON AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60502-6548
Mailing Address - Country:US
Mailing Address - Phone:630-334-7491
Mailing Address - Fax:
Practice Address - Street 1:6040 STATE ROUTE 53 STE C
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-3394
Practice Address - Country:US
Practice Address - Phone:630-524-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL20510341041S0200X
IL149.0205171041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL349181018Medicaid