Provider Demographics
NPI:1437465283
Name:SCHMIDT, ANGELA EVA (MS)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:EVA
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MISS
Other - First Name:ANGELA
Other - Middle Name:EVA
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:521 OTTER AVE
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54901-5103
Mailing Address - Country:US
Mailing Address - Phone:414-315-9323
Mailing Address - Fax:
Practice Address - Street 1:404 N MAIN ST
Practice Address - Street 2:SUITE 507
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-4957
Practice Address - Country:US
Practice Address - Phone:414-315-9323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-30
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI544226104100000X
WI5077-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100013367Medicaid