Provider Demographics
NPI:1316790413
Name:SCHMIDT, NICHOLE (LSW, CADC, MAC)
Entity type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:LSW, CADC, MAC
Other - Prefix:
Other - First Name:NICHOLE
Other - Middle Name:
Other - Last Name:SCHULTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25242 COLLIGAN ST
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:IL
Mailing Address - Zip Code:60442-1415
Mailing Address - Country:US
Mailing Address - Phone:708-475-3804
Mailing Address - Fax:
Practice Address - Street 1:25242 COLLIGAN ST
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:IL
Practice Address - Zip Code:60442-1415
Practice Address - Country:US
Practice Address - Phone:708-475-3804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL31778101YA0400X
IL154469101YA0400X
IL150110612104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)