Provider Demographics
NPI:1265004295
Name:SCHUMANN, MOLLY A (MS ED, BCBA)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:A
Last Name:SCHUMANN
Suffix:
Gender:F
Credentials:MS ED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3777 S 19TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53221-1505
Mailing Address - Country:US
Mailing Address - Phone:414-418-9573
Mailing Address - Fax:
Practice Address - Street 1:2341 N HOLTON ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-3355
Practice Address - Country:US
Practice Address - Phone:414-367-6654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1-21-51121103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst