Provider Demographics
NPI:1508539602
Name:SCHUMITSCH-JEWELL, TAYLOR
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:SCHUMITSCH-JEWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2069 N CAMBRIDGE AVE APT 219
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-1046
Mailing Address - Country:US
Mailing Address - Phone:414-721-6726
Mailing Address - Fax:
Practice Address - Street 1:7322 W RAWSON AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-8117
Practice Address - Country:US
Practice Address - Phone:414-266-3339
Practice Address - Fax:414-433-9007
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-26
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI101Y00000X
WI7859-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1508539602Medicaid