Provider Demographics
NPI:1376311373
Name:SCHOEN, NEIL JOHN GASSAMA (PSYD)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:JOHN GASSAMA
Last Name:SCHOEN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2428 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53083-4916
Mailing Address - Country:US
Mailing Address - Phone:262-305-8543
Mailing Address - Fax:
Practice Address - Street 1:2428 N 8TH ST
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53083-4916
Practice Address - Country:US
Practice Address - Phone:262-305-8543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4092-57103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist