Healthcare Provider Details

I. General information

NPI: 1235479551
Provider Name (Legal Business Name): DEBRA SUE SCHNOOR LCSW, CSAC, MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2013
Last Update Date: 07/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 DEWEY AVE
WAUWATOSA WI
53213-2504
US

IV. Provider business mailing address

36500 AURORA DR
SUMMIT WI
53066-4899
US

V. Phone/Fax

Practice location:
  • Phone: 414-454-6779
  • Fax: 414-454-6450
Mailing address:
  • Phone: 414-773-4312
  • Fax: 262-434-5809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number15675-132
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number128174-121
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8082-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: