Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 15641-131 | WI |
NPI | 1003192279 |
---|---|
Provider Name | Maggie Schaefer |
First Address | Schofield, WI 54476-2338 |
Second Address | Schofield, WI 54476-2338 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2011 |
Last Update Date | 01/11/2011 |