Provider Demographics
NPI:1386755494
Name:SCHILLO, ERIC L
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:L
Last Name:SCHILLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 KENYON RD STE C
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-5718
Mailing Address - Country:US
Mailing Address - Phone:515-573-3138
Mailing Address - Fax:515-373-3130
Practice Address - Street 1:7177 HICKMAN RD STE 3
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50322-4844
Practice Address - Country:US
Practice Address - Phone:515-570-5818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02683104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker