MEDICARE: GRETCHEN LEE SCHUCHARD LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	4754	ND
2	104100000X	Social Worker	4754	ND

General Provider Information

NPI Number	:	1043949548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRETCHEN LEE SCHUCHARD LMSW

Provider Business Mailing Address
First Line	:	1308 ELBOWOODS LANE
Second Line	:
City	:	BISMARK
State	:	ND
Zip	:	58503-5712
Country	:	US
Telephone Number	:	701-751-8260
Fax Number	:	701-751-2274

Provider Business Practice Location Address
First Line	:	1308 ELBOWOODS LANE
Second Line	:
City	:	BISMARK
State	:	ND
Zip	:	58503
Country	:	US
Telephone Number	:	701-751-8260
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2022
Last Update Date	:	11/15/2024

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