Provider Demographics
NPI:1669619920
Name:SCHAFER, BLANCHE (LPC)
Entity type:Individual
Prefix:
First Name:BLANCHE
Middle Name:
Last Name:SCHAFER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:BLANCHE
Other - Middle Name:
Other - Last Name:GUCWA/KRULL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2050 RIVERSIDE DR STE 108
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-2364
Mailing Address - Country:US
Mailing Address - Phone:920-785-8560
Mailing Address - Fax:920-391-5099
Practice Address - Street 1:2050 RIVERSIDE DR STE 108
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-2364
Practice Address - Country:US
Practice Address - Phone:920-785-8560
Practice Address - Fax:920-391-5099
Is Sole Proprietor?:No
Enumeration Date:2009-01-08
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6211101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1669619920Medicaid