Provider Demographics
NPI:1366032658
Name:SCHRANK, CONNIE (CSAC, ICS)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:SCHRANK
Suffix:
Gender:F
Credentials:CSAC, ICS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 W BLUEMOUND RD
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-2787
Mailing Address - Country:US
Mailing Address - Phone:262-202-6805
Mailing Address - Fax:
Practice Address - Street 1:2000 W BLUEMOUND RD
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-2787
Practice Address - Country:US
Practice Address - Phone:262-202-6805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-21
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15142101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty