| Doctor Name: | MR. JASON PETER SCHALLACK |
| NPI Number: | 1003104324 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MFA |
| License Number: | |
| Business Practice Address: | 1414 Main St Melrose Park, IL - 601603902 |
| Business Phone Number: | 7086810073 |
| Business Fax Number: | 7086813958 |
| Mailing Address: | 539 Belleforte Ave, OAK PARK |
| State: | IL |
| Postal Code: | 603021623 |
| Phone Number: | 7086810073 |
| Fax Number: | 7086813958 |
| NPI Enumeration Date: | 07/20/2011 |
| NPI Last Update Date: | 07/20/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |