MEDICARE: KATHY SCHAUBLE CSAC

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	15336-132	WI

General Provider Information

NPI Number	:	1548270986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHY SCHAUBLE CSAC

Provider Business Mailing Address
First Line	:	1610 MILLER PARK WAY
Second Line	:
City	:	WEST MILWAUKEE
State	:	WI
Zip	:	53214-3604
Country	:	US
Telephone Number	:	414-672-6026
Fax Number	:

Provider Business Practice Location Address
First Line	:	1610 MILLER PARK WAY
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53214-3604
Country	:	US
Telephone Number	:	414-672-6026
Fax Number	:

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

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	07/29/2010

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