Provider Demographics
NPI:1871676528
Name:SCHNEIDER, KATHRYN ALICE (CADC III)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ALICE
Last Name:SCHNEIDER
Suffix:
Gender:F
Credentials:CADC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4404 STATE ROAD 70
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:WI
Mailing Address - Zip Code:54893
Mailing Address - Country:US
Mailing Address - Phone:715-635-6519
Mailing Address - Fax:
Practice Address - Street 1:4404 STATE ROAD 70
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:WI
Practice Address - Zip Code:54893
Practice Address - Country:US
Practice Address - Phone:715-635-6519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39381600Medicare ID - Type UnspecifiedAODA COUNSELOR