Provider Demographics
NPI:1508915794
Name:SCHIBLINE, DAVID J (LCSW)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:SCHIBLINE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4731 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-9355
Mailing Address - Country:US
Mailing Address - Phone:920-648-3052
Mailing Address - Fax:
Practice Address - Street 1:1425 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-6707
Practice Address - Country:US
Practice Address - Phone:920-683-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39696700Medicaid