Provider Demographics
NPI:1861547598
Name:SCHUCH, KRISTEN MARIE (MA)
Entity type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:MARIE
Last Name:SCHUCH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N9516 COUNTY ROAD U
Mailing Address - Street 2:
Mailing Address - City:ALGONA
Mailing Address - State:WI
Mailing Address - Zip Code:54201
Mailing Address - Country:US
Mailing Address - Phone:920-318-9512
Mailing Address - Fax:
Practice Address - Street 1:2339 CEDAR RIDGE
Practice Address - Street 2:INNOVATIVE COUNSELING INC
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54313
Practice Address - Country:US
Practice Address - Phone:920-497-6161
Practice Address - Fax:920-498-0476
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40983200Medicaid